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A TEXT- BOOK 



MATERIA MEDICA 



THERAPEUTICS AND PHARMACOLOGY 



GEORGE F. BUTLER, PH.G., M.D. 

Associate Professor of Therapeutics in the College of Physicians and Surgeons, Chicago 
Professor of Medicine and Therapeutics, Dearborn Medical College, Chicago. 



jffttb JE&ftfon, GborougblE IRevteefc anD "Rewritten 

Bnt> Boapteo to tbe TSigbtb fRevision (1005) of tbe TBI. S. ipbarmacopceta 



SMITH ELY JELLIFFE, M.D., Ph.R 

Professor of Pharmacognosy and Instructor in Materia Medica and Therapeutics in Columbia 
University (College of Physicians and Surgeons), New York. 



PHILADELPHIA AND LONDON 

W. B. SAUNDERS COMPANY 
1906 



LIBRARY of CONGRESS 
Two CoDics Received 

JAN 26 1906 

Copy right Entry 

J»*"<*£ /fat 

tLASS (Z XXc, No, 



.'V 



^ 



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sK 






Set up, electrotyped, printed, and copyrighted October, 1896. Revised, reprinted, and recopyrighted 

September, 1898. Revised, reprinted, and recopyrighted August, 1899. Reprinted May, 

1900, and June, 1901. Revised, reprinted, and recopyrighted April, 1902. 

Reprinted April, 1903. Revised, rewritten, electrotyped, printed, 

and recopyrighted January, 1906. 



Copyright, 1906, by W. B. Saunders Company 



PRESS OF 
B. SAUNDERS COMPANY 
PHILADELPHIA 



TO 



THE MEDICAL STUDENTS OF THE UNITED STATES, 

IN THE HOPE THAT IT MAY AID THEM IN ATTAINING A CORRECT 

KNOWLEDGE OF THE NATURE AND ACTION OF DRUGS 

AND THE RATIONAL TREATMENT OF DISEASE, 

THIS WORK IS CORDIALLY INSCRIBED BY 

THE AUTHOR. 



PREFACE TO FIFTH EDITION. 



The present edition has been entirely remodelled, rewritten and 
reset. The past four years has seen a remarkable activity in the 
study of pharmacological phenomena. Numerous studies in the 
newly opened fields of physical chemistry have contributed largely 
to the interpretation of hitherto partly understood physiological 
functions which in turn have opened up more satisfactory explana- 
tions of the results of pharmacological experimentation. 

In this present edition many of the practical results of this newer 
work have been incorporated and brought in coordination with the 
heretofore accepted facts of materia medica and therapeutics. 

The thought that this is essentially a book for students and for 
practitioners has been kept closely in mind. It is not meant for 
experimental workers in pharmacology. Especial attention has been 
given to the toxicology of the newer compounds recently introduced 
into medical practice, and the author has had occasion carefully to 
scrutinize his therapeutic recommendations and eliminated much 
that has rested on hypothetical rather than on practical grounds. 

In general the arrangement of the book has been so changed 
that those drugs whose predominant action is on one system of 
organs of the body are grouped together, thus suggesting their thera- 
peutic as well as their pharmacological alliances. It is recognized 
that any system of grouping has its drawbacks and its defects, but 
the present is believed to be thoroughly practical and useful. 

The work has been considerably reduced in size by the use of 
more compact type and by the elimination of much material from 
the chapter on serum therapy. Much of this material belongs more 
properly in works on pathology, and only those features have been 
retained which are of importance to modern therapeutics. 

S. E. J. 

January 22, 1906. 



PREFACE. 



The present work has been undertaken with the immediate 
object of supplying the student of medicine with a clear, concise, 
and practical text-book, adapted for permanent reference no less 
than for the requirements of the class-room. 

The arrangement — embodying the synthetic classification of 
drugs based upon therapeutic affinities — the author believes to be 
at once the most philosophical and rational, as well as that best 
calculated to engage the interest of those to whom the academic 
study of the subject is wont to offer no little perplexity. 

Should an intelligent and comprehensive understanding of 
Materia Medica and Therapeutics be facilitated by the author's 
treatment of the theme, the deductions derived from his experience 
as a practitioner and instructor will not have been committed to 
print in vain. 

Special attention has been given to the Pharmaceutical section, 
which there is reason to hope will be found exceptionally lucid 
and complete. It has been deemed advisable, however, in the 
general work to include in the descriptive enumeration only such 
drugs as experience has proved to be of .unquestionable value 
and are of standard and authoritative acceptance in general prac- 
tice. In accordance with this plan, many new and comparatively 
untried remedies have been omitted, since, while of established 
efficacy in certain conditions, they are as yet too imperfectly known 
to warrant association with remedial agents bearing the sanction 
of exhaustive scrutiny. So, too, a few official drugs have been 
excluded because they are practically never used or are employed 
only in isolated instances. 

It will be observed that " "Untoward Action" and "Poisoning" 

11 



12 PREFACE. 

are treated under separate heads. By the former it is intended to 
record the effects of medicinal doses in developing certain symp- 
toms dependent more or less upon individual susceptibility, not 
necessarily assuming the aggravated form incident to toxic doses, 
which exert a definite influence regardless of idiosyncrasy. 

In giving the careful Latin accent and quantity of medicinal 
nomenclature (Foster), so far as practicable with the prosodial 
signs employed, the design has been to correct a prevalent dis- 
regard of proper pronunciation reflecting little credit upon those 
to whom a knowledge of the subject should be as exact as it is 
familiar. To the prescription-writer the appropriate Latin genitive, 
and in a few cases the accusative, will doubtless afford valuable 
assistance. 

During the preparation of the work many important text- 
books, periodicals, etc. have been freely consulted, and from the 
U. S. Pharmacopoeia chiefly, and from the National Dispensatory, 
have been adopted almost verbatim the "Origin" and "Description 
and Properties " of the various drugs under consideration. 

In reviewing the progress of the present volume the author 
desires to express his cordial acknowledgments to Prof. Carl S. N. 
Hallberg, Ph. G., whose exhaustive contribution of "Weights and 
Measures" and "Pharmaceutical Preparations" cannot fail to 
lend permanent interest to the work ; to Dr. Alfred C. Cotton, Dr. 
Wm. E. Quine, and Dr. James B. Herrick, for friendly suggestions ; 
to Dr. D. Lee Shaw, Dr. Fred C. Zapffe, and Dr. Thomas J. Jack- 
son, for assistance in compilation. To Mr. Storrow Higginson the 
author's personal thanks are due for his scholarly assistance in 
the revision of the text. 

G. F. B. 



CONTENTS. 



PAGE 

INTRODUCTION 17 

PHARMACOLOGY AND GENERAL THERAPEUTICS 21 

Modes of Introduction of Remedies 41 

Untoward Effects of Drugs 49 

Classification of Medicines 58 

Weights and Measures 59 

PHARMACEUTICAL PREPARATIONS 64 

Solutions 65 

Aquae Medicatae — Medicated Waters 67 

Liquores — Solutions 67 

Spiritus — Spirits 73 

Syrupi — Syrups 74 

Elixiria — Elixirs ' 80 

Glycerita — Glycerites 86 

Liquid Mixtures — Internal 87 

Misturae — Mixtures 87 

Emulsa — Emulsions 90 

Extractive Preparations 94 

Infusa — Infusions 95 

Decocta — Decoctions 96 

Aceta — Vinegars 96 

Vina — Wines 96 

Tincturae — Tinctures 98 

Fluidextracta — Fluidextracts 103 

Extracta — Extracts 108 

Oleoresinae — Oleoresins 109 

Resinae — Resins no 

Solid Mixtures for Internal Use in 

Pulveres — Powders 112 

Sales Eff ervescentes — Effervescent Salts 115 

Confectiones — Confections 116 

Trochisci — Troches 117 

Massae — Masses 118 

Pilulas— Pills 118 

Unofficial Forms of Mixtures of Solids for Internal Use 124 

Preparations for External Use 125 

Linimenta — Liniments 125 

Lotiones — Washes 127 

Oleata — Oleates 128 

Olea Infusa — Infused Oils 128 

Collodia — Collodions 129 

Unguenta — Ointments 129 

13 



14 



CONTENTS. 



PAGE 

Cerata — Cerates 132 

Suppositoria — Suppositories 133 

Emplastra — Plasters 134 

Chartse — Papers 135 

Poultice or Catapalsm 136 

Fomentations 136 

Spongiopiline 136 

Plaster Mull 136 

Caustics or Escharotics 136 

Bandages, Antiseptic Dressings 136 

Medicated Dressings , 137 

Medicated Cottons 137 

Medicated Gauzes — Carbasa 137 

Plaster-of -Paris Bandages 138 

DRUGS WHOSE CHIEF ACTION IS ON THE NERVOUS SYSTEM... 139 

The Alcohols 139 

General Anesthetics 153 

Hypnotics 164 

Motor Depressants 218 

Motor Excitants 226 

DRUGS ACTING CHIEFLY ON THE CIRCULATORY ORGANS 235 

The Digitalis Group 235 

DRUGS ACTING CHIEFLY AS VASOCONSTRICTORS 248 

Xanthine Derivatives 256 

Drugs Acting Chiefly to Inhibit Cardiac Activity and to Cause Vasodilatation 260 

Vasodilators 268 

DRUGS ACTING LOCALLY ON MICRO-ORGANISMS (ANTISEPTICS) 276 

Oxidizing Germicides 277 

Metals and Their Salts 280 

Acids, Alkalies, Salts, etc 280 

Halogens 283 

Aromatic and Fatty Compounds 289 

VOLATILE OILS, RESINS, OLERESINS, BALSAMS 316 

Irritants and Counterirritants 318 

Aromatic Vehicles and Carminatives 330 

Condiment Group 342 

Group of Aromatics Used Particularly to Stimulate the Mucous Membranes 

of the Genito-urinary or Respiratory Tracts 347 

Aromatics Used for Their Supposed Antispasmodic Action on the Nervous 

System 358 

ANTIPYRETICS AM) ANTIPYRETIC ANALGESICS 364 

Quinolin Group 365 

Pyrrhol Group 373 

Hydrazine Derivatives 375 

Anilines 376 

ALTERATIVES 382 

Heavy Metals Used for Local Purposes 414 

VI ;< ! ETABLE ASTRINGENTS 439 

ACI1 >S— ALKALIES— SALTS 45° 

DRUGS ACTING CHIEFLY ON THE GASTRO-INTESTINAL ORGANS 493 



CONTENTS. 15 

PAGE 

Bitters 493 

Digestants 498 

Fats and Oils 501 

Emetics - 505 

Cathartics 516 

Laxatives 520 

Simple Purgatives 526 

Hydragogue Purgatives .' 533 

Saline Cathartics 539 

Anthelmintics 541 

DRUGS ACTING PARTICULARLY ON THE UTERUS 548 

Emmenagogues and Ecbolics 548 

DRUGS ACTING ON THE RESPIRATORY MUCOUS MEMBRANES. . . 553 

Expectorants 553 

DRUGS ACTING PARTICULARLY ON THE KIDNEYS 561 

Diuretics 561 

DIAPHORETICS 569 

MISCELLANY 578 

TOPICAL REMEDIES 587 

Rubefacients 587 

Caustics or Escharotics 589 

Emollients, Demulcents, and Protective Agents 594 

ANIMAL EXTRACTS (ORGANOTHERAPY) 604 

Serum-Therapy . 607 

PRESCRIPTIONS 616 



GENERAL INDEX 639 

CLINICAL INDEX. 665 



A TEXT-BOOK 

OF 

MATERIA MEDICA, 

PHARMACOLOGY, AND THERAPEUTICS, 



INTRODUCTION. 



The history of medicine since the earliest times is the record of 
a more or less continuous series of experimental researches, having 
for their paramount object a precise and comprehensive knowledge 
of the nature of disease and the practical application of remedial 
agents. The various " schools " which have arisen from time 
to time are philosophically co-ordinate, their fundamental prin- 
ciples being referable to one dominating thought — the art of 
healing. 

It is scarcely practicable here, even were it necessary, to review 
in detail the separate doctrines which have obtained during the 
evolution of sectarian therapy. From the earliest ideas promul- 
gated by the ancient priests of ^Esculapius, through the subse- 
quent era of Hippocrates, Theophrastus, and the Alexandrian 
school, influenced by the crude, misguided notions prevailing ere 
science emerged from its infancy ; discernible in the Galenic and 
other tentative yet memorable systems, in the epoch of Paracelsus 
and the Monastic Medicine of the Mediaeval period, and in the 
radical theories of Rasori and Roeschlaub which attended the 
development of the eighteenth and have left a passing impress upon 
the nineteenth century, — through all, the gradual acceptance of 
empiricism as a legitimate guide to therapeutic truth is manifest. 
Yet viewed with reference to their underlying animus, these varied 
expressions of scientific endeavor distinguishing the part are per- 
ceptibly linked with the ampler system which has emanated from 
the more rational methods of modern research. 

2 17 



18 A TEXT-BOOK OF MATERIA MEDICA. 

The light of inductive reasoning and the marvellous progress in 
scientific knowledge which characterize the nineteenth century are 
a living appeal from the idealism of a less enlightened age. The 
release from tradition — anticipated in the labors of Bichat and 
others — to which later investigation owes so many signal triumphs 
has doubtless been profoundly affected by the realistic tendency of 
modern thought. It is to the startling advancement attained in the 
natural sciences, however, resulting in a chemical skill and in me- 
chanical appliances of incomparable value, that we must look for 
the originating impulse which has inspired the therapeutic know- 
ledge of the present day. It needs but little reflection to perceive 
the immeasurable superiority of actual acquirements over the vague, 
hesitating — though ardent and laborious — methods to which the 
theory and practice of medicine were so long subservient. 

We have said that, considered in the larger sense, the history of 
medicine has been a harmonious rather than an intermittent devel- 
opment. It is not to be supposed that, in the evolution of so 
momentous a scheme as the formulation of a remedial system 
applicable to the extensive catalogue of human ailments, there 
should not have occurred spasmodic and ill-adjusted theories, 
crystallizing in many a strange adtus, which, if ineffectual in 
retarding the onward sweep of rational progress, has, it may be 
safely averred, worked incalculable injury to the cause of medical 
truth. Mesmerism, astrology, spiritualism, even theosophy, how- 
ever incongruously conjoined, and similar vagaries have not failed 
to enlist among their votaries many enraptured, even noted, be- 
lievers ; nor is the mental strabismus with which they are afflicted 
amenable to any resource of rational treatment. We need, more- 
over, but contemplate the pitiable hallucinations which urge the 
pious pilgrimages to Marpingen, Lourdes, and Treves, and the 
criminal negligence and incredible offence to reason which stultify 
the so-called " Christian Scientists " (as ironical a misnomer as lan- 
guage permits), to realize that miraculous cures still hold blighting 
yet potent sway over the minds of the ignorant and credulous. 
May not even the assumption of thaumaturgical powers be one 
day possible with those who arrogate to themselves a knowledge 
little short of omniscience, and to whose rudimentary intelligence 
the laws of nature convey no perceptible lesson ? As from the 
sublime to the ridiculous, so from faith to fanaticism, it is but a 
Step, after all. 

It is appropriate here to emphasize the unfailing — nay, ever- 



INTRODUCTION. 19 

increasing — importance of therapeutics in its relation to the wel- 
fare of mankind. Especially imperative is this obligation in an 
epoch of unprecedented achievement in every department of science 
which contributes to the perfection of the healing art, in which 
general advancement medicine has borne no inconspicuous role. 

The rapid advance of experimental science, however, applied 
to medical treatment, culminating in bacteriological discoveries of 
signal value to mankind, and the remarkable triumphs attending 
the development of operative surgery, have inevitably tended to 
disparage the equally noble and far more widely cultivated field of 
therapeutic science. This result is the more deplorable since it 
creates in the minds of the young and inexperienced an impression 
of contrast and divergence in departments of study naturally and 
indissolubly correlated. It is scarcely surprising that the marvels 
of the laboratory and the splendid achievements of the arena should 
possess for the tyro an entrancing interest. Yet it is to be borne in 
mind that the most brilliant triumphs of diagnostic and surgical 
skill might prove futile as the means of arresting disease were they 
not supplemented by the course of treatment which constitutes 
therapy. 

It must be confessed that medical art has too often been dis- 
credited by professional incompetence, and consequent failure to 
effect the cure which with the laity is wont to form, however ignor- 
antly, the only criterion of ability. In America especially — where 
from defective laws the widest latitude is given to incapacity and 
imposture — the lack of proper academical training is frequently 
the cause of serious consequences in practice, little calculated to 
enhance the popular confidence and esteem. It therefore behooves 
the student of medicine to master thoroughly the details of the 
remedial art, become practically conversant with physiological 
conditions and the manifold phenomena of morbid anatomy, and 
so familiarize himself with the varying indications of disease that 
in the presence of whatever malady, his diagnosis and treatment 
may command respect — not only from the laity, but, what is of far 
more consequence to him, from the profession. 

It is almost superfluous to lay stress upon pharmaceutical know- 
ledge as a powerful weapon in the armament of the medical prac- 
titioner. Yet no branch of therapeutic science has, perhaps, been 
more neglected than a practical acquaintance with the nature and 
uses of Materia Medica, their origin, potency, and characteristic 
value, as well as their physiological action, and the incompatible 



20 A TEXT-BOOK OF MA TERIA MEDICA. 

and synergistic agents upon which their efficacy often largely 
depends. 

Thanks to careful and competent training among pharmacists, 
the skilful preparation and dispensing of drugs relieve the physi- 
cian of much responsibility ; yet he should be keenly sensible of 
the fact that the larger share of public confidence is reposed in 
him, and by diligent study of the subject endeavor to command 
the minutiae of pharmacology, holding himself morally accountable 
for errors quite possible in the druggist's dispensary. It may not 
be irrelevant to add that in all medical procedure a sympathetic 
yet perfectly controlled nature, ready tact, and sterling common 
sense are cardinal requisites to professional triumph, it being gene- 
rally true, as was long since observed by Hufeland, that " success- 
ful treatment requires only one-third science and two-thirds savoir 
/aire." 

Finally, the author would counsel the utmost seriousness in 
the pursuit of a calling which might aptly be termed " Christian 
Science " — the power to alleviate human suffering by means of 
curative agents with which the laboratory of nature has been 
mercifully stored. There can be no loftier, more practical mani- 
festation of love to men than is exemplified in the benignant effort 
to assuage the ills to which mortality is heir ; nor can any devotion 
be more privileged and inspiring than that which softens the shock 
of disease, illumines the darkness of mental and physical distress, 
and from the debris of misfortune, vice, and heredity creates anew 
the image of divine perfection. It is this uplifting, consecrated 
zeal, akin to veneration for medical science, which has endeared to 
the world the masters of the profession — of which the same wise 
Hufeland said : " To him who fails to make a religion of the heal- 
ing art it is the most cheerless, wearisome, and thankless labor 
upon earth ; indeed, in him it must become the greatest frivolity 
and a sin." And for those — and they are many — to whom the 
material, possibly mercenary, aspect of their task appeals unduly 
it is enough to cite in rebuke the elevated maxim of Stigelius : 

Non omnia quae suscipimus lucrum spectant. 
[ Thunbergii Dissertationes.] 



PHARMACOLOGY AND GENERAL THERAPEUTICS. 



Nature heals, physicians treat — is a truth of old that is con- 
stantly forgotten : always by the patient, who expects the patent 
medicine or the family doctor to cure her ; frequently by the 
physician, who is often persuaded, against his better judgment, to 
believe in the supernatural when the mysteries of drug action are 
involved. A few propositions concerning the general action of the 
human body in its endeavor to heal itself may not be out of place 
in an introduction to a work on the practice and art of aiding 
nature's forces in the treatment of abnormal conditions. 

It is a difficult task to express, in a few phrases, the general 
causes of disease, but the following general agencies may be con- 
sidered : 

1. Trauma, whether the result purely of accident, or brought 
about in the general struggle for existence. 

2. Parasites, both microscopical and macroscopical, acting within 
and without the body. 

3. Poisoning from plants and animals, broken down and decom- 
posed food-stuffs, and poisonous gases taken into the respiratory 
tract. 

4. Bad hygiene, unwise modes of living, including faulty nutri- 
tion, faulty modes of dress, eating, and housing, use or abuse of 
certain organs or their lack of use. 

5. Heredity. — Here would be classified not only the directly 
transmissible diseases, as syphilis, but also those constitutional 
dyscrasiae that conduce to premature break-down of some part of 
the human body. 

In order to combat these various agencies the individual organs 
have developed a system of natural cure methods (" natural thera- 
peutics ") that are of interest. These may be summarized briefly, 
following Robert, in part, as : 

1. Healing by regeneration. Among the lower animals the 
regeneration of a lost member is not infrequent, but in man it is 
unusual. In a sense, however, the healing of wounds as a part of 

21 



22 A TEXT-BOOK OF MATERIA MEDICA. 

the inflammatory reaction is analogous to this process in the lower 
animals. The hypertrophy of one kidney, compensating for the 
loss of the other, and the establishment of a collateral circulation 
are illustrations of what Bachmann, in 1894, pointed out as the 
law of equivalent compensations. 

2. Healing may be brought about by the exercise of an organ. 
Thus, the old-fashioned system of exposure to wet and weather 
develops, by exercise of the skin, an increased resistance to agencies 
that otherwise might react harmfully on the organism. 

3. In the struggle against parasites it would appear that the 
body had developed an extensive array of protective agencies. 
Thus, antiseptic substances in the saliva, gastric juice, and bile are 
simple instances of this protective power against parasites from the 
outside. The doctrine of phagocytosis embodies the principle of 
the action of the white blood-cell in its office as a protective agent. 
In the body-fluids are found alexins, a7ititoxi?is } immunizing pro- 
teids that protect from the actions of poisons which may develop 
as a result of the life activities of these parasites should they obtain 
a foot-hold within the body — or even protect from poisons devel- 
oped in the course of disturbed metabolism. Fever, so frequently 
regarded as an adverse sign in disease, undoubtedly serves in large 
part as a means of protection of the body — by killing the agents 
that have induced the rise in temperature. 

4. Healing from certain poisons is brought about by vomiting 
and diarrhea, by rapid elimination through diuresis, or by excessive 
perspiration. Within the body a most interesting series of changes 
often takes place — thus, splitting up of poisons, their oxidation or 
conversion, or even fixation, into non-toxic products is a constant 
phenomenon. Thus even so powerful an alkaloid as morphine is 
said by Faust to be in part oxidized and perhaps used as a food- 
stuff The chemical changes that take place in the liver have here 
their most potent activities, and the pathological chemistry of the 
twentieth century promises to throw much light on these compli- 
cated problems. Poisons also are compensated for by the process 
of adaptation (habituation), and are frequently rendered inert by 
the development of specific antitoxic substances. Thus specific 
anti-morphine bodies have been developed in the blood of some of 
the lower animals. 

The physiological process of rest is an expression of nature 
healing. Loss of appetite is the indication not to eat. Pain calls 
for n 



PHARMACOLOGY AND GENERAL THERAPEUTICS. 2$ 

6. Healing by the casting off of a portion of the organism is a 
process of nature healing widely made use of in diseases among 
plants and the lower animals. Abscess formation, the limiting, by 
fibrinous exudates, of intraperitoneal irritants, and spontaneous 
gangrene of the extremities are well-recognized examples of such 
a type of nature's healing. 

Treatment is something apart from healing, and in its broad 
sense comprises all those means, psychical or physical, which the 
practiser of the healing art has at his command by which he can 
hope to alter an abnormal condition in the individual he is called 
on to treat. Thus, nature calls into play the highest of her gifts, 
intelligence, to aid her in the work of self-preservation, and it is 
the function of the text-book to aid, in so far as it is able, to train 
that intelligence in the facts that experience has proved of value — 
in the present instance, in the fields of materia medica, pharmaco- 
dynamics, and therapeutics. 

Pharmacology, from the broad point of view, is the science 
of drugs, and includes the various fields of medical botany, med- 
ical zoology, pharmacognosy, pharmacodynamics, and pharmacy. 
Within recent years, however, following the German school, its 
meaning has been restricted and made equivalent to pharmaco- 
dynamics, or the study of the effects of physical or chemical 
agencies on living organisms. It is in this sense that it is used in 
this work. 

Materia Medica is the study of the materials, organic and 
inorganic, used for drugs in their physical and chemical characters. 

Pharmacognosy is a division of materia medica, and includes 
the technical study of the crude materials from which drugs are 
derived. Its deliberation is limited to the animal and the vegetable 
kingdoms, but it is not a science with sharply defined boundaries, as 
it encroaches on so many avenues of knowledge — systematic bot- 
any, zoology, gross and minute anatomy, chemistry, and pharmacy. 

Pharmacy is largely a chemical study. It deals with those 
manipulations by which the potent principles of drugs are rendered 
available for therapeutic purposes. 

Therapeutics is the art and practice of treating abnormal bodily 
states. It has for its object the restitution to the normal, or, if 
such is impossible, the giving of comparative comfort to the invalid. 
Its range of activity, therefore, is extremely wide, and a combina- 
tion of methods is necessary to the resourceful physician. The 
following general modes of treatment should be considered : 



24 A TEXT-BOOK OF MATERIA MEDICA. 

Suggestion Therapy. — There is little question that the oldest 
systematic form of therapeutics was a type of suggestion therapy. 
In the old type of " Temple Sleep " we find the earliest use of this 
form of therapy. Magnus l has shown that the earliest relations of 
religion and medicine were to be found in the " Temple Sleep " pro- 
cedure. To the earliest Egyptians priest and physician were one. 
There were priests not physicians it is true, but no physicians who 
had not priestly functions. Throughout the entire Egyptian civili- 
zation this double function flourished and even passed on into the 
Grecian system, where it persisted for centuries. We all know that 
certain organs of the body were under the care of certain gods or 
goddesses — some singly, some having charge of many organs if 
not the whole body. The early Egyptian god, Thoth, had the 
digestion under his particular care, and it is said that this mythical 
personage invented the clyster pipe. Thus the modern formula, 
" Fear God and keep the bowels open," is apparently of prehistoric 
Egyptian origin. The rationale of much of this priest therapy was 
to sleep in the temple of the god overnight. There in the quiet 
and repose of the holy place, providing it were not too popular, the 
god would appear to the sick one in the form of a dream, and 
would designate the remedy needed. Modern clairvoyant quacks 
pursue the same method. No. 59 for colds, so extensively adver- 
tised, is said to have been devised in a similar manner. 

This method of treatment, it is known, was not uncommon even 
as late as the time of the Roman emperors. 2 In the Greek tem- 
ples all were allowed save those so hopelessly ill that it seemed 
foolish. The procedure for those patients admitted to the temple 
was for the priests to narrate the wonderful results to be obtained 
by the step which was to be taken ; thus was desirable confi- 
dence imparted. Then various prayers and ceremonies were gone 
through with and certain sacrifices made ; the sacrifice being the 
ancient analogue of the " fee." After the " preliminary " conditions 
had been complied with, the ancient priest, it may be observed, 
obtained his retaining fee in advance, those patients who were more 
well-to-do were placed in front of the statue of the god on the 
skin of the sacrificed ram, while the poor were permitted to lie 
down on a bundle of rags in one corner of the temple. Great 
stress was then laid on the character of the dreams the patient would 
have as he slept, for the advice of the god would come in the 

1 " Relation of Medicine and Religion," Culturgesehicthliche Bilder aus der Ent- 
wickelu% f lichen Standes t 1890. 

Suetonius and Vespasian, Vespasianus, 7, No. 20. 






PHARMACOLOGY AND GENERAL THERAPEUTICS. 25 

dream. History has recorded some fearful and wonderful dreams. 
^Esculapius is said to have demanded 120 ounces of blood for one 
venesection. Aristides was put by the gods on a diet of raisins to 
cure what appeared to be neurasthenia from too much exhorting. 
It is significant that the ancient gods commanded their patients to 
go fishing, to go hunting and swimming, and frequent attendance 
of theatres was an urgent remedy. It was highly essential, in 
fact obligatory, that the priests should interpret the dreams. 

The treatment of temple sleep was the result of a profound 
religious feeling, and it was carried out with great decorum and 
seriousness. Implicit and devout confidence in the gods was a 
sine qua non. Thus the temple sleep, separated from its religious 
accessories, is the prototype of the systematic treatment by sugges- 
tion, and this suggestion therapy strutting about in the garb of 
religion has remained an inseparable companion of the human 
race from the most remote times of Egyptian civilization up to the 
present day. With all peoples and at all times, even during our modern 
century, suggestion has been active in the garb of religion ; only that 
this religious garb has frequently changed according to altered 
religious and cultural ideas. Faith is one of the oldest therapeutic 
agencies of which anything is known. As Dr. Osier 1 has so well 
said, " Faith in the Gods or in the Saints cures one, faith in little 
pills another, hypnotic suggestion a third, faith in a plain common 
doctor a fourth. In all ages the prayer of faith has healed the 
sick, and the mental attitude of the suppliant seems to be of more 
consequence than the powers to which the prayer is addressed. 
The cures in the temples of ^Esculapius, the miracles of the Saints, 
the remarkable cures of those noble men, the Jesuit missionaries, 
in this country, the modern miracles of Lourdes, and the wonder- 
workings of the so-called Christian Scientists are often genuine and 
must be considered in discussing the foundations of therapeutics." 
" Physicians use the same power every day. If a poor lass, par- 
alyzed, apparently helpless, bed-ridden for years, comes to me, 
having worn out in mind, body, and estate a devoted family, and 
she in a few weeks or less by faith in me, and faith alone, takes up 
her bed and walks, the saints of old could not have done more." 
" The faith with which we work, the faith, indeed, which is available 
to-day in every-day life, has its limitations : it will not raise the 
dead : it will not put in a new eye in place of a bad one, nor will 
it cure cancer or pneumonia or knit a bone ; but in spite of the 

1 Medicine of the Nineteenth Century, 1 90 1. 



26 A TEXT-BOOK OF MA TERIA MEDICA. 

nineteenth century restrictions, such as we find it, faith is a most 
precious commodity without which we should be very badly off." 

Of the various forms of suggestive treatment it is not necessary 
here to treat. One form, treatment by hypnosis, is worthy of 
careful study, but its details are out of place here. 

Heliotherapy, exposure to the rays of the sun, or, in Finsen's 
latest developments, to the activities of the x-rays ; aerotherapy, 
or exposure to the open air, moist air, dry air, superheated air, etc. 
— both constitute modes of treating some forms of disease. Much 
might be said of Climatotherapy, the principles of which are not 
well understood. Dietetic Therapy. — This is also a method of 
antiquity. Diet — milk cures, vegetarian diet, meat diets, diets for 
obesity, for diabetes, etc. — has extreme practical importance, and 
its principles should be thoroughly mastered by the student. 

Physicomechanical Therapy. — This includes a large number 
of useful procedures — Kinesotherapy, or massage and Swedish 
movements, from which the fantastical osteopathy has developed, 
is one of the most important. The Chinese and Japanese have 
used massage for a thousand years, and it constitutes one of their 
most important therapeutic procedures. Tissot, in 1780, brought 
the methods in use once more in Europe; Schebe, of Germany, in 
1847, an< 3 Zander, of Stockholm, in 1865, brought the modern 
gymnastic procedures to a state of perfection. 

Hydrotherapy, involving the use of heat and cold, with modi- 
fied massage, has justly become a most important therapeutic pro- 
cedure. E. F. C. Oertel, of Bayreuth, in 1765, and Preissnitz, in 
1790, may be regarded as the founders of modern hydrotherapy. 
Its most useful applications are to be found in reducing tempera- 
ture, in promoting sleep, and in neurasthenic and weakened nervous 
states, although its applications in one form or another are numerous. 
Tonsillitis, pharyngitis, conjunctivitis, abdominal pain, ovarian neu- 
ralgias, etc., are all benefited by hot applications. 

Hypodcrmoclysis and enteroclysis are special forms of hydro- 
therapy which are of great value. 

Electrotherapy. — Electricity is a potent agent in the treatment 
of certain forms of disease. Within recent years more definite ideas 
have been gained regarding the mode of its action. Space does 
not permit of more than an indication of the merest outlines in this 
place, the student being referred to text-books on the subject 
(Jacoby, " Electrotherapeutics "). 



PHARMACOLOGY AND GENERAL THERAPEUTICS. 2*] 

In general, two types of current, galvanic and faradic, are 
employed both for diagnostic and for therapeutic purposes. The 
galvanic current is of constant flow, low intensity, and small in 
quantity. It has little influence in causing muscular contractions, 
but has marked chemical and thermal properties and promotes 
metabolism. The faradic current consists of alternating to-and-fro 
currents, is usually of high intensity, and has marked power to 
promote muscle contractility. The knowledge of the different 
modes of application should be gained from a good text-book. 

In using electricity for diagnostic purposes it is advisable to use 
the minimum amount of current to produce a desired effect. The 
two sides of the body should be carefully compared, and the 
patient should be at rest. It is advisable to have similar electrodes, 
and they should be applied to corresponding areas on the well side 
and the supposedly diseased side. 

The condition of muscular contractility is investigated in using 
the galvanic current by making and breaking the current. Under 
the influence of small to medium currents the normal reaction 
of a muscle should be that the anodal closure contraction is less 
than the cathodal closure contraction, thus, A.C.C. < C.C.C. In a 
muscle that is just beginning to show signs of a loss of muscular 
contractility the A.C.C = C.C.C, whereas if the anodal closure con- 
traction is greater than the cathodal closure contraction the reaction 
is known as the reaction of degeneration, and is an evidence of dis- 
ease. Reaction of degeneration must result from almost any 
extensive lesion of the peripheral motor neuron. It is found in 
extensive neuritis from toxic causes, alcohol, lead, zinc, carbon 
disulphide, mercury, malarial poisoning, etc., in acute anterior 
poliomyelitis or other disease involving the cells in the anterior 
horns of the cord ; it may also occur with extensive muscle disease. 

From a therapeutic point of view electricity is having a con- 
stantly widening application. The use of the x-rays in lupus and 
in flat epitheliomata is as certain as it is marvellous, and the appli- 
cation of the Finsen phototherapy is but in its infancy. Electricity 
is widely employed as an irritant, caustic, and escharotic. In 
paralyses of spinal and neuritic origin its properties of stimulating 
metabolism make it a highly desirable therapeutic measure. When 
combined with massage and infinite pains and tact, continued for 
long periods of time, seemingly hopeless paralyses may be very 
markedly relieved. Eternal persistency is sometimes the price of 



2S A TEXT-BOOK OF MATERIA MEDICA. 

recovery. In sensory affections the static current often is of ser~ 
vice. Mental suggestibility is here an important item, and the 
static machine lends itself very readily to much quackery. Galvan- 
ism is often very useful in relieving the deep-seated pains of sciatica 
and lumbago. By many, electricity is deemed of no value, and by 
others as a panacea for all ills. The truth lies in the means. In 
proper hands it is an exceedingly useful agent, but it has fallen 
very much in the estimation of the profession because of the 
great use made of electricity by the charlatan and professional 
parasites on that portion of society that so delights in being hum- 
bugged. 

Toxicology. — Pharmacology and toxicology are in a sense the 
same. They represent quantitative variation only. All pharma- 
cological action represents some variation from normal standards. 
When such variations reach a point where the disturbance of func- 
tion threatens to be or is fraught with danger to the well-being or 
life of the organism, then the subject is suffering from the toxic 
action of such an agent. 

Pharmacotherapy. — This includes the study of remedial agents 
proper or the use of drug substances. It considers the applica- 
tions of the teachings of pharmacology to the treatment of abnormal 
body states. It naturally constitutes the most important branch 
of therapeutics. 

It is not to be supposed that our present elaborate systems of 
pharmacotherapy have come into existence as they now are found. 
They have had a natural development, and the various methods 
have merged, the one into another. Certain arbitrary methods 
have received special names, such as Empirical, Specific, Statistical, 
Physiological, Rational Therapeutics, etc. 

Empirical Therapeutics implies the application of remedies to 
which experience has ascribed certain specific properties irre- 
spective of systematic value. It is not based upon experimental 
rch, but rather upon formula; established by the accumula- 
tion of isolated facts — empiricism — and practical observation, apart 
from theoretical reasoning and the relations of physiological phe- 
nomena as revealed by modern methods of investigation. Were 
it possible to extend indefinitely the list of remedial agents so as 
to embrace the entire field of therapeutic knowledge, the empirical 
method might attain the dignity of an exact science. Such, how- 
ever, is the complexity arising from the manifold, often contra- 



PHARMACOLOGY AND GENERAL THERAPEUTICS. 29 

dictory, impressions drawn from human experience that for the 
evolution of a systematic scheme of therapeutics the empirical 
system must of necessity prove inadequate. 

By Specific Therapeutics is meant a system of treatment that 
implies that certain diseases have certain definite antidotes. Thus, 
mercury and the iodides are specifics for syphilis, antitoxin for 
diphtheria, antivenin for snake-bite, etc. 

Statistical Therapeutics implies a method of treatment that is 
the outcome of the experience of the results observed in a large 
number of cases under certain restricted lines of treatment. This 
method arrives at excellent results if sufficient numbers of cases of 
the same type can be observed, but disease processes vary so 
widely in different individuals that the statistical method alone is 
not unlikely to lead to error. 

Physiological Therapeutics consists in the application of the 
strict interpretations of the pharmacodynamic action of drugs to 
diseased conditions. With increasing knowledge its principles will 
prove more and more applicable, but the inherent difficulties of 
interpretation of all biological phenomena will always make this 
method unsatisfying. 

Rational Therapeutics is a term much in use, but it means simply 
an application of the various criteria, empirical, statistical, experi- 
mental, etc., in the treatment of diseased processes. The rationalist 
cares less for the name of the disease and more for the disturbance 
of general organic functions, not isolated symptoms, but group 
symptoms, which indicate some large functional disturbance. 

On the General Action of Drugs. — Broadly speaking, the action 
of drugs is exerted either locally or systemically, whereas the 
effects which are known as reflex action occupy a middle ground 
between the two. Many drugs have only a limited action at the 
point of application, while others possess not only a local, but a 
systemic, action as well. 

The action of drugs is fundamentally a question of protoplasm 
chemistry, but the investigations of the biologist have not yet 
reduced the interpretations of nature to a question of molecular 
physics ; until they do, pharmacology will retain the words irrita- 
tion, stimulation, depression, paralysis, and death of protoplasm. 
Hueppe, in 1891, enunciated the doctrine that all remedies first, in 
small doses, produced an irritant and stimulating action in proto- 
plasm, to be followed, when used in larger doses, by a depressing 



30 A TEXT-BOOK OF MATERIA MEDIC A. 

or paralyzing action, which might go on to death of the protoplasm 
acted on. Thus the effects of small and large doses were con- 
trasted ; the foundations of the homeopathic idea are closely related 
to this interesting phenomenon. It is not a universal phenomenon, 
however, and cannot be designated as a law, as Hueppe claimed. 
There are a large number of substances that in small and large 
doses have antagonistic effects, but the antagonism is by no means 
an equal one. Thus is it a familiar illustration that small doses of 
morphine increase mental activity by slight stimulation, whereas 
large doses depress and paralyze and bring about unconsciousness. 
The grade of excitement cannot at all be made commensurate with 
the grade of depression by making the doses smaller and smaller. 
Chloral acts as an irritant to the peripheral nerve-endings, although 
it depresses and paralyzes the central nervous system. Citations 
might be multiplied to show the host of inconsistencies and varia- 
tions. 

If such variations are found to be true for the action of drugs 
on the normal human body, how much more variable are the 
results of pharmacotherapy on the diseased organism. At times a 
given agent acts with less force on a diseased organ than on a 
healthy one ; at times again with greater activity, and still further 
the action of a drug may vary widely in health and in disease. 

At the present time the limits of present-day information offer 
but little hope for a better interpretation of these questions, and 
not only is the clinical side of the problem obscure, but the chemi- 
cal side is equally uncertain. It seems that different chemical 
actions must be considered. Many compounds seem to react on 
protoplasm with a mutual disarrangement of the molecules ; thus 
the action of strychnine is interpreted ; others act on the tissues 
and are eliminated unchanged, and yet have probably altered the 
chemical character of the tissues acted on. Of late years, through 
the studies of followers of Nernst and Ostwald, an entirely new 
scries of studies have been carried on which are destined to be 
closely related to the study of the physiological action of drugs. 
The study of electrolytic dissociation has already opened up new 
fields in physiology, and the ground is being broken in pharma- 
cology. In the salts of the alkalies are found a series of actions 
differing from those already spoken of; here the active agent 
induces changes in the watery content of the protoplasm or in the 
water of the liquids surrounding the cells, and brings about a 



PHARMACOLOGY AND GENERAL THERAPEUTICS. 31 

series of physical, rather than chemical, changes. The familiar 
experiments of plasmolysis in the botanical laboratories illustrate 
this action, which is controlled by the general laws of diffusion of 
liquids, which are separated by animal or vegetable membranes. 

In the animal body many salts are found in solution, not as 
complete molecules, but as made up of their electrical components, 
or ions, one positive and another negative, and when a chemical 
action takes place, it is an action not between the molecules of the 
salt and the protoplasm, but between an ion of the salt and the 
protoplasm, or even ions of the protoplasm molecule. For many 
of the simpler inorganic compounds, NaCl, KC1, KBr, KI, K(OH), 
many metallic salts, etc., the action of the ions is fairly well estab- 
lished. Thus the effects of strong, hypertonic, weak or dilute, 
hypotonic, and normal, isotonic, salt solutions on blood-cells, on 
muscle-cells, and on nerve-cells are well known and readily explica- 
ble under the now known laws of ion dissociation. Space does 
not permit of a more extended discussion of this interesting phase 
of the subject. 

Physiological Action and Chemical Composition. — If the action of 
drugs is fundamentally a chemical one, then, on a priori grounds, 
it maybe inferred that chemical compounds with similar dissociable 
ions will bring about similar physiological reactions. This general 
line of thought opens up a most fascinating field, which is daily 
offering more and more positive deductions, especially along the 
line of the newer synthetic preparations. 1 The newer work on ion 
dissociation alluded to in the previous paragraph is also to be con- 
sidered in this connection. 

Many years ago Blake suggested and worked out a complicated 
scheme of the toxicity of the metals, based on the periodic law of 
Mendeljeff, 2 but it would seem, for the present, that the time has 
not yet come when such relationships will prove of any practical 
interest. 

In the field of organic chemistry, however, the fundamental 
truths of the relationships of chemical structure and physiological 
action have given to pharmacotherapy some of its most highly 
prized drugs. The ingenuity of the pharmaceutical chemist is 
being taxed to the utmost in the search for new compounds. 

1 See Frankel, Arzneimittel Synthese, 1901. 

2 He showed that between certain limits there existed certain relations between the 
molecular weights, the spectrum analysis, and the physiological action of the metals. 



32 A TEXT-BOOK OF MATERIA MEDIC A. 

Along other lines equal diligence has been shown. Thus, a 
large number of the newer synthetic remedies have their draw- 
backs : their action is marred by certain unpleasant by-effects that 
have no relationship to the main action of the drug. Many are too 
readily soluble and exert a local action on the stomach, when it is 
desired that they reach the intestines ; others are insoluble and do 
not act where it is desirable to have them do so — as, for instance, 
many of the intestinal antiseptics and astringents. Many other 
illustrations might be instanced. 

One of the most fascinating problems connected with this sub- 
ject is that of the combination of the useful activities of different 
synthetics. Thus it is possible to combine a hypnotic acting radi- 
cle with an analgesic, and in one compound get a combination of 
the two. Other desirable combinations naturally occur. It is 
unfortunate that this problem has been often accomplished very 
satisfactorily from the chemical point of view, but when the physio- 
logical test has been applied, the compound has been worthless, 
both actions having been lost by some modification of one or the 
other main action. 

The possibilities of the problems are extensive, but the difficul- 
ties are many. One warning note should, however, be sounded. 
Notwithstanding the many excellent results that have been accom- 
plished by pharmaceutical chemists, there seems to be a tendency 
on the part of many to offer to the medical profession a vast number 
of so-called new synthetics. These are not at all new, but are 
well-known old compounds or very slight modifications of popular 
compounds that do not differ at all in their main actions. Such, 
by dint of extensive advertising and ingeniously devised " clinical 
reports," they force on the practitioner as very valuable new 
synthetics. Reference is not here made to the imposition of the 
compounding of well-known remedies, such as acetanilid, etc., and 
the putting forth of the same under proprietary names as new syn- 
thetic compounds. Such are the sharks that prey upon the legiti- 
mate pharmaceutical chemist who is making honest efforts to give 
the profession much-desired remedies. They also prey on the 
community In that, under the guise of a secret name, they commit 
economic robbery, supplying at exorbitant rates what can be sup- 
plied anywhere at rational prices. 

Relation of Physical Chemistry to Pharmacology and Thera- 
peutics. — Perhaps no departments of medicine have been so sub- 



PHARMACOLOGY AND GENERAL THERAPEUTICS. 33 

ject to the criticism " unscientific " as those of pharmacology and 
therapeutics. Pharmacologists still hold the most contradictory 
positions regarding the action of specific drugs ; and therapeutists 
have at their disposal but few means which enable them to predict 
with definiteness the course of disease. Our modern therapeutic 
nihilism is undoubtedly the reaction of a thinking medical profession 
against an antiquated empiricism. But, as is customary with such 
reactions, the pendulum has swung too far backward. In order to 
restore it to its right position it is necessary that we reconstruct our 
knowledge of pharmacology and therapeutics, and, by beginning 
with its simplest problems, slowly rebuild it upon a basis of newer 
interpretations more in accord with modern science. 

It is impossible, in this limited space, even to touch upon all the 
points at which physical chemistry offers immediate results in its 
application to the problems of pharmacology. In these pages, 
therefore, we shall consider only the applicability of the theory of 
electrolytic dissociation to the problems in hand. 

According to the dissociation theory of Arrhenius, when strong 
acids, bases, or salts are dissolved in water (or certain other 
solvents), either all or a part of the molecules are split by the 
water into simpler substances — the electrically charged atoms or 
groups of atoms known as "ions." Since these strong acids, 
bases, and salts upon solution conduct the electric current, they 
are known as " electrolytes." According to Arrhenius' theory ^ 
then, a solution of hydrochloric acid is made up not only of HO 
molecules, but also of H-ions and Cl-ions. Similarly, a solution 
of sodium hydroxide contains not only molecules of NaOH, but 
also Na-ions and OH-ions. Ions are charged with positive or 
negative electricity. The negatively charged ions, which travel to 
the positive pole, are termed " anions " ; those charged with positive 
electricity, and traveling toward the negative pole, are termed 
" kations." Thus the ions of a completely dissociated hydro- 
chloric acid solution may be written H + and C1-. 

We cannot here bring forward even a few of the facts that go 
to prove the truth of the dissociation theory of Arrhenius ; but 
there are an abundance of the same to show that the chemical 
(and consequently the physiological, pathological, and pharmaco- 
logical) effects of most of the electrolytes are entirely dependent 
upon their constituent ions, and are independent of the nature of the 
molecules. For example : hydrochloric acid dissociates into H- 



34 A TEXT-BOOK OF MA TERIA MEDICA. 

and Cl-ions ; NaCl dissociates into Na- and Cl-ions. These solu- 
tions are the same in so far as they both contain Cl-ions, but dif- 
ferent in that one contains H- and the other Na-ions. These 
differences determine the differences in the properties of the two 
solutions. 

A single experiment may serve to fix more clearly the fact that 
it is, indeed, the zons, and not the molecules, that determine the 
activity of an electrolyte in solution. If an iron nail is put into an 
aqueous solution of HC1, the iron is immediately attacked and H 
is liberated. If, however, the nail is put into a solution of HC1 in 
benzene, no such chemical action takes place. The water in the 
first case converts the HC1 into H- and Cl-ions. Benzene has 
practically no such dissociating powers, and the HC1 remains in 
the molecular state. The molecules of HC1 are incapable of 
attacking the iron. 1 

It may, then, be accepted as true in general that the chemical 
characteristics of an electrolyte are dependent upon the nature of 
the ions contained therein. Thus the chemical characteristics of 
an aqueous solution of HC1 are determined by the H- and Cl-ions 
it contains. All acids yield H-ions, and it is because of this fact 
that all acids have certain general properties. The differences 
between the solutions of two different acids that contain the same 
number of H-ions are determined by the differences between their 
anions. Since, now, the physiological effects of a substance are 
dependent upon its chemical nature, and since the chemical nature 
of an electrolyte is, in the main, dependent upon the nature of its 
ions, it follows that the physiological effects of an electrolyte are 
determined by the nature of its ions. 

When an electrolyte is administered as a therapeutic agent, 
before it can produce any effect it must be in solution. Water is 
the universal solvent in the body. But when an electrolyte is dis- 
solved in water, it is dissociated into ions. The therapeutic effects 
of such an electrolyte must, then, be dependent upon the ions 
which it yields. For example, in the administration of a dose of 
sodium iodide, we deal not with the effects of the Nal molecules, 
but with the effects of the Na- and 1-ions into which the sodium 
iodide dissociates. 

Although Dreser showed in icSo4"that the relative toxicity of 
the mercury salts is determined by the number of Hg-ions that 
the salt yields upon solution in water, and although Kahlcnberg 






PHARMACOLOGY AND GENERAL THERAPEUTICS. 35 

and True were the first to show that the poisonous effects of 
various electrolytes upon the roots of the bean are determined by 
the nature of their ions, the credit of recognizing the widespread 
physiological importance of the theory of electrolytic dissociation 
belongs to Jacques Loeb. 

A series of papers originating from the laboratory of this 
investigator have brought proof of the following facts. The 
poisonous effects of acids and alkalies 2 upon muscle are deter- 
mined by the number of the H- and OH-ions they yield, and is 
independent of the nature of the acid (in the case of the inorganic 
acids) or alkali. Another paper 3 shows that the amount of water 
absorbed by a muscle from equimolecular salt solutions is in- 
fluenced not only by the laws of osmotic pressure, but also by the 
nature of the ions in the solutions. The absorption of water from 
equimolecular solutions of sodium, potassium, and calcium salts 
by muscle is analogous to the absorption of water by the Na-, K-, 
and Ca-soaps, for while muscle absorbs but little water in the 
sodium solution, it absorbs an enormous amount in the potassium 
solution, while it actually loses water in the calcium solution. A 
most important contribution to our knowledge of life phenomena 
is found in the discovery that Na-ions are absolutely necessary for 
the production of rhythmical contractions in voluntary muscle, 4 in 
heart muscle, 5 and in the contractile swimming bell of the medusa. 6 
Yet a heart beating rhythmically in a pure sodium chloride solu- 
tion soon comes to a standstill. If, however, a little calcium be 
added, the heart may continue to beat for hours. 

What bearing, now, has the theory of electrolytic dissociation 
upon the problems of pharmacology? We have for years been 
accustomed to see the effects of different salts grouped under 
general headings. Thus we have become acquainted with the 
general effects of potassium and sodium salts, the salts of iron and 
lead, and the general properties of iodides and bromides. Never, 
however, has the question been asked, Why do these salts arrange 
themselves in such groupings ? We have learned that certain salts 
having certain characteristics in common may at will be substituted 
for one another. We have known, moreover, that although certain 
groups of salts, such as the salts of Hg, Ag, Pb, Cu, etc., all have 
highly poisonous properties, yet that the fatal dose of the individual 
members of such groups differs greatly from one another. Then 
we have been impressed with the fact that many organic salts, or 



36 A TEXT-BOOK OF MATERIA MEDICA. 

salts combined with organic substances, are either entirely without 
effect, or else behave entirely differently from the ordinary salts. 
These are a few of the facts which become at once intelligible in 
the light of the dissociation theory. 

We have said before that in the process of solution an electro- 
lyte is dissociated, and that in consequence we deal, in the main, 
no longer with the properties of its molecules, but of the ions that 
constitute the molecules. We know, for example, that we can 
substitute, at will, sodium iodide for potassium iodide in order to 
produce certain therapeutic effects. These salts are alike in that 
they both yield I-ions ; they differ in that the former yields Na- 
ions, while the latter yields K-ions. Any similarity manifested in 
the therapeutic effects of these two salts is determined by the 
similarity of their anions. But we know that the potassium iodide 
is much more depressant than the sodium salt. This is due to the 
direct poisonous effects of the K-ions upon muscle and nerves, an 
effect not exhibited by Na-ions. It is because all the iodides yield 
I-ions that they are grouped under a general heading. It is the 
effect of the I-ions that we seek in administering this drug in 
syphilis. Provided we give equal doses of I-ions, one salt may at 
will be substituted for the other. It is the secondary benign or 
deleterious action of the kations, however, which determines 
which salt we employ. 

Similar reasoning applies to the bromides. We have long 
known of the hypnotic effects of the bromine salts and the specific 
effects of the bromides in epilepsy. These effects are due to the 
Br-ions, and one salt is as good as the other, provided it yields the 
same number of Br-ions, and its good qualities are not offset by a 
deleterious action of the kations. Experience with the bromides, 
moreover, brings to light the fact that it is indeed the Br-ions that 
<letermine the desirable effects of bromine compounds. Clinicians 
have long been acquainted with the fact that organic compounds 
•containing bromine do not produce the effects given by the inor- 
ganic salts. This is because these organic compounds containing 
.bromine do not yield any Br-ions at all, or because they yield only 
such small quantities as to be without effect in the doses adminis- 
tered. The same facts explain why manufacturers have been 
unsuccessful in producing an organic compound of bromine which 
could at all rival the ordinary inorganic salts. 

The theory of electrolytic dissociation also explains why iron 
salts have certain general characteristics possessed by no other 



PHARMACOLOGY AND GENERAL THERAPEUTICS. 37 

salts, and why the salts of Hg, Ag, Pb, Cu, etc., are classed in 
groups by themselves. In these instances, however, the charac- 
teristic activity of the salt is determined by the kations, for the 
effects of the Hg-ions, Pb-ions, etc., evidence themselves long 
before the effects of the anions spring into prominence. In the 
cyanides, again, the anions are the effective agents and determine 
the characteristics of their group. KCN and HCN show similar 
effects, perhaps, because they both yield CN-ions, and these mani- 
fest their effects in doses so small that sight is lost of the K- and 
H-ions. 

Several years ago Dreser 7 showed that the toxic effects of mer- 
cury salts are determined by the number of Hg-ions they yield 
upon solution. When mercuric chloride is added to albumin a 
precipitate is formed which can be readily dissolved in sodium 
thiosulphate, forming a so-called complex mercury salt. When 
the mercury exists in this complex form it loses its toxic proper- 
ties, and even though equal weights of the metal be present, the 
complex salt is unable to inhibit fermentation ; and frogs, fishes, 
etc., poisoned with it instead of the sublimate die more slowly. 
Dreser finds an explanation for these phenomena in the fact that 
the double salt is either not dissociated at all, or yields only a 
small number of Hg-ions. In cold-blooded animals the salt is 
slowly decomposed, and the toxic effects of Hg-ions formed 
poison the animal. In warm-blooded animals the decomposition 
occurs much more rapidly, and in consequence not much differ- 
ence was found between the toxic effects of the mercuric salt and 
its more complex derivative. Yet all local irritative manifestations 
were lacking in the latter case. 

There have recently appeared upon the market various organic 
compounds of silver (protargol, nargol, etc.) which have come into 
general use as substitutes for silver nitrate. It seems that these 
compounds exhibit all the beneficent and only a few of the 
deleterious qualities of silver nitrate. Undoubtedly an explana- 
tion similar to that given by Dreser holds here too. Silver nitrate 
owes its specific action to the Ag-ions it yields. The organic 
silver compounds probably yield none or only a small number of 
such ions. When, however, the organic compound is introduced 
into the body, it is decomposed, and the Ag exerts its specific 
effects to a degree dependent upon the number of Ag-ions 
liberated. These facts explain the differences in the behavior 
between the organic and the inorganic silver salts. 



38 A TEXT-BOOK OF MATERIA MEDICA. 

Paul and Kr6nig, s and, more recently, Scheurlen and Spiro, 9 
have been able to show that the bactericidal power of solutions of 
electrolytes is dependent upon the ions contained in them. Equi- 
molecular solutions of mercury salts arrange themselves according 
to their degrees of electrolytic dissociation in the following order : 
HgCl 2 , HgBr 2 , Hg(CNS) 2 , Hgl 2 , HgCy 2 . When arranged accord- 
ing to their bactericidal powers, the order is the same. This power 
is then dependent upon the number of Hg-ions contained in the 
solution. HgCl 2 , which contains the largest number, has the 
strongest germicidal action, while HgCy 2 , which is least disso- 
ciated, has the feeblest. So weak is the action of the cyanide that 
at a concentration four times that of a bichloride solution capable 
of destroying all cocci and spores it permits the development of 
several thousand colonies of the staphylococcus and many colonies 
of the anthrax bacillus. If K-ions are substituted for the Hg-ions 
by the substitution of KC1 for HgCl 2 in the antiseptic solution, the 
germicidal powers of the solution are decreased, another fact which 
proves that the Hg-ion is the specific germicide. These facts 
effectively dispose of the conception of Behring, still held by 
many, that the bactericidal power of a mercurial is dependent upon 
the amount of mercury contained in it, and is independent of the 
nature of the compound. 

The germicidal effects of silver and gold salts are similarly 
found to be dependent upon the Ag- and Au-ions. That it is, 
indeed, the ions which are thus effective is proved by the fact that 
solutions of HgCl 2 or AgN0 3 in absolute alcohol or ether (solvents 
in which but slight dissociation occurs) have no deleterious effect 
upon anthrax spores. 

Recently Loeb lu u has pointed out the influence of the valency 
and possibly the electrical charge of ions upon their toxic and 
antitoxic effects. Previous experiments had brought to light the 
poisonous character of a pure sodium chloride solution for the 
development of fish embryos, or on the beat of the heart. But these 
toxic effects are done away with when a small amount of calcium 
is added to the sodium chloride solution. Thinking that these 
were only special instances of a more general law, Loch inves- 
tigated the toxic and antitoxic effects of ions upon the develop- 
ment of the eggs of FundulllS, a marine fish. The eggs of this 
fisll develop equally well in sea-water (their ordinary habitat), in 
distilled water, or in sea-water the concentration of which has been 
raised by the addition of NaCL In a pure sodium chloride solu- 



PHARMACOLOGY AND GENERAL THERAPEUTICS. 39 

tion, however, of the same concentration as that of the sea-water, 
not a single embryo develops. If, now, a small though definite 
amount of a calcium salt be added, the poisonous effect of the 
NaCl solution is annihilated, and the eggs develop into embryos. 
Not only is calcium able to bring about this effect, but any bivalent 
kation serves the same purpose — Ca, Ba, Mg, Fe, Co, and even 
Zn and Pb. The nature of the anion is immaterial. 

But these facts hold not only for the poisonous effects of a pure 
NaCl solution, but also for the poisonous effects of solutions of 
other salts, of univalent kations with univalent anions — LiCl, KC1, 
NH 4 C1. From these experiments, then, the general conclusion 
may be drawn that a small amount of a bivalent kation suffices to 
annihilate the poisonous effects of the pure solution of a salt com- 
posed of a univalent kation with a univalent anion. It has been 
further shown that a trivalent kation may at will be substituted for 
the bivalent kation, and that a much smaller amount of a trivalent 
kation (Cr, Al) suffices to annihilate the poisonous effects of a 
pure sodium chloride solution than is required of the bivalent 
kation. Finally, a quantitative relation exists between the amount 
of the toxic salt and the amount of a bivalent kation necessary to 
annihilate its poisonous effects. With an increase in the concen- 
tration of the pure NaCl solution there is a corresponding increase 
in the minimal amount of the bivalent kation necessary to do away 
with its toxic effects. 

These facts are of the greatest biological significance and of the 
most wide-spread applicability. A preliminary note announces 
that the valency and possibly the electrical charge of ions in- 
fluence in a similar way the toxic effects of pure salt solutions 
upon muscle. The effect of a calcium salt in overcoming the 
poisonous effects of a pure sodium chloride solution upon the 
rhythmical contraction of a heart muscle strip becomes at once 
intelligible as a specific instance of the above-mentioned general 
law. 

Loeb's experiments give us an insight, moreover, into the 
method by which ions possibly influence protoplasm. Some 
time ago he pointed out the fact that in dealing with the proper- 
ties of protoplasm we are dealing, in the main, with the physics of 
a colloidal solution in which are dissolved certain salts. The ex- 
periments of Hardy have demonstrated most clearly the influence 
of the electrical charge of ions upon the physical state of colloidal 



40 A TEXT-BOOK OF MATERIA MEDICA. 

particles. It requires a large amount of a univalent ion to cause 
the coagulation of a colloid, but a small amount of a bivalent, or a 
still smaller amount of a trivalent, ion will accomplish the same 
purpose. Loeb believes that similar facts may possibly underlie 
the toxic and antitoxic effects of the salts. If the electrical charge 
determines the antitoxic effects of a kation, then it becomes at 
once apparent why a small amount of a bivalent, or a still smaller 
amount of a trivalent, positively charged kation suffices to neu- 
tralize the poisonous effects of a pure sodium chloride solution. 

The theory of electrolytic dissociation is only one of the many 
developments of physical chemistry that promises much if applied 
to the problems of pharmacology or the biological sciences in 
general. We must attribute a large part of our present ignorance 
concerning the general laws that underlie the action of drugs to 
the failure to recognize and utilize the fruits of this new science. 
Innumerable papers still appear in which the physiological, patho- 
logical, and pharmacological effects of percentage solutions of 
various electrolytes are compared. Only chemically equivalent 
solutions can be compared. It is to such violations of the simple 
laws of physical chemistry that many of the erroneous results 
obtained in the biological sciences are to be attributed. 

The action of electrolytes must be analyzed into the action of 
their constituent ions. Ultimately we shall have a classification 
of the electrolytes based upon the action of the ions contained in 
them. Once we grasp the notion that the activity of a given sub- 
stance is determined by the ions it yields upon solution we shall, 
perhaps, find a method of rearranging our system of dosage upon 
this basis — a process analogous to the regulation of the dosage of 
crude drugs based upon their alkaloid content. 

REFERENCES. 

i. See Fischer, Medical Reeord t 1901, March 30, where a review of the literature 
in ita application to physiology and pathology is givm in greater detail. 
2. Loeb, I]/li< >rs Arch. % 1S97, lxix., j>. 1. 
]. Loeb, ///./., 1899, Ixxv., p. 303. 

4. Loeb, " Beirrlge txxt Physiologic," Ftstsckr. f. A. 1-ick, 1S99, p, ioi. 

5. Lingle, Am. Jour. Physiol. % 1900, iv., p. 265. 

6. Loeb, />'</</., 1900, iii., p. 383. 

7. Dreser, Arch./, txp. Pathol, u Pharmakol., i8q;. xxxii., p. 456. 
Paul and Kronig, Zeitsckr. f.pkysik. Ckem. t 1896, xxi., p, 414. 

9. Scbenrlen and spin., htUnckener »if,{. Wochtnschr %l 1897, xliv., p. 81. 
10. Loeb, //.' , 1901, lxxxviii., p, 68. 

ir Loeb, ./";. /cur. I'hy tul., 1902, vi., p. 41 1. 



MODES OF INTRODUCTION OF REMEDIES. 4 1 

MODES OF INTRODUCTION OF REMEDIES. 

Remedies may be applied externally to the skin or internally to 
many mucous membranes, either as a local application or to bring 
about systemic action. 

Methods of Skin Medication. — The passage of drugs through 
the unbroken skin takes place in a small degree only. The follow- 
ing methods are applicable : Enepidermic method, consisting of the 
application of cataplasms, fomentations, washes, vapor-baths, etc. 
Epidermic methods, or the methods of inunction ; these are widely 
applicable. In such the drug is dissolved or suspended in some 
oily or fatty medium and made to penetrate the deeper layers of 
the skin by persistent and thorough rubbing. The thinner skinned 
portions of the body, such as the axillae, groins, beneath the knee, 
and inner elbow surfaces are those most frequently used. The 
method is valuable for general absorption, especially in the mer- 
curial administration for syphilis and in the use of methyl salicy- 
late (oil of wintergreen) in rheumatism, but it lacks precision in 
dosage. Endermic method, by which the skin is blistered and the 
drug is applied to the free corium ; it has many serious disadvan- 
tages. 

Hypodermic Method. — This consists in injecting the drug into 
the subcutaneous tissues by means of the hypodermic needle and 
syringe. Since absorption by the tissues takes place readily, it will 
be seen that this method of application is far more efficacious than 
those previously mentioned. Not all drugs, it is to be observed, 
are available for administration by the hypodermic process of 
injection. The eminent success attending the operation, however, 
renders it of signal value to the physician. 

This method was first used in a practical manner by Wood, of 
Edinburgh, in 1853. A syringe with glass rod and glass barrel 
accurately ground is the best now on the market. If carefully 
made, it will not leak and is never out of order. Those with metal 
barrels and leather washers dry out when not in constant use, 
and are never in condition when required. The all-glass syringe, 
moreover, can be sterilized at any time. This cannot be said of 
other varieties. A barrel holding about 30 minims is the usual 
size. After filling, all air should be excluded. The skin should 
be pinched up slightly, and the needle inserted rapidly and 
obliquely ; some prefer to insert the needle at right angles, but this 



42 A TEXT-BOOK OF MATERIA MEDICA. 

is unnecessary, and if contaminated solutions should happen to be 
used, deep abscesses are produced. The insertion of the deltoid, 
outer aspect of the thighs, and deep muscles of the back are 
favorite sites. Solutions of drugs should not be used. It is pref- 
erable to use soluble hypodermic tablets ; these are best dissolved 
in a teaspoonful of water heated over a flame ; after cooling, the 
solution can be injected without causing pain. Prompt action 
follows this method, accurate dosage is assured, and disturbance 
of the gastric or intestinal mucosae is avoided. As a rule, the dose 
by this method is 25 per cent, less than when given by the mouth. 

Vaccination is a method of skin medication. In males it is best 
performed over the insertion of the deltoid, and in females there or 
at the upper outer portion of the leg. The thigh is troublesome 
to dress and necessitates greater exposure. For scarification the 
best instrument is a fine needle, which should be sterilized in a 
flame before using. The site selected should be cleansed thor- 
oughly with soap and water ; hard rubbing will aid in peeling 
away bacteria infected epidermis. Three or more scratches, \ of 
an inch apart and \ of an inch long, are then made, and the vaccine 
is rubbed in thoroughly either with a sterilized wooden toothpick 
or with the glass of a capillary tube. The capillary tube of 
glycerinated bovine lymph with a small balloon to expel the virus 
is the best form of virus now in use. With bovine virus the 
dangers from syphilis and tuberculosis are ni/, and thorough 
cleansing of the arm avoids erysipelas or other septic infections. 

Hypodcrmoclysis is a method of applying remedial agents 
through the skin. As a rule, 0.6 per cent, normal salt solution is 
used — a dram of table salt to a pint of boiled and filtered water. 
The site preferred is the anterior wall of the abdomen or the ilio- 
lumbar region, above the ilium and below the ribs. Thorough 
asepsis is necessary in the technic. An ordinary fountain syringe 
with a moderate sized needle is all that is required. The solution 
is best used at a temperature of from 1 io° to 1 1 5 ° F., and from 4 
to 8 ounces are employed. The method is extremely useful in 
conditions of shock, hemorrhage, diarrhea, uremia, and in toxic 
.states generally. 

Local Applications to Mucous Moubrancs. — TJic liyc. — Here 
lotions (collyria) of boric acid or hot water are applied. Oint- 
ments and caustics are applied directly. Calomel may be dusted 
into the eye for sluggish chronic inflammatory conditions. 



MODES OF INTRODUCTION OF REMEDIES. 43 

The Ear. — This is reached by direct application, or by means 
of syringe. Alcoholic solutions of mild antiseptic drugs, such as 
boric acid, may be employed, the evaporation of the menstruum 
depositing the antiseptic in place. The ear is also reached by the 
Eustachian catheter from the inside. 

The Nose. — Direct application of caustics or astringents can be 
made to the nose. Sprays and insufflations of antiseptic solutions 
or powders are useful. For children one of the most efficient 
methods of cleansing the posterior pharyngeal vault, which often 
is necessary in scarlet fever, measles, influenza, etc., in order to 
avoid middle-ear infection, is to let the little patient lie on his back, 
and, by means of a tablespoon, the antiseptic solution can be 
placed directly in the nose. Children will permit, even enjoy, this, 
when no amount of coaxing will persuade them to submit to the 
use of a spray. Moreover, a spray rarely cleanses the entire nasal 
cavity. 

The Pharynx is reached best by direct application of absorbent 
cotton on an applicator. The applicator is made capable of being 
bent so as to reach the posterior pharynx. Solutions of cocaine, 
4 per cent, and freshly prepared solutions of suprarenal gland, 10 
to 50 per cent., are widely employed as local applications for anes- 
thetic and astringent purposes in these localities. Gargles are now 
largely superseded by direct applications, sprays, or by syrupy or 
mucilaginous solutions containing astringent drugs. 

Respiratory Tract. — As a means of producing anesthesia the 
respiratory tract has been utilized for some time. Opium is also 
taken in this manner by the opium-smoker. The confirmed 
cigarette inhaler also utilizes the respiratory tract. In young 
children breathing of steam, medicated or not, is an efficient means 
for treating spasmodic laryngitis, bronchitis, and bronchopneu- 
monia. It is probable that the breathing of medicated vapors, as 
advocated by the disciples of the pneumatic cabinet, as a means of 
treating tuberculosis of the respiratory passages is largely illusory. 

Rectum. — Medication as well as feeding by means of the rectum 
is indicated in conditions of great irritability of the stomach or 
under special circumstances, such as stenosis of the esophagus, 
gastric cancer with stenosis of the cardiac entrance, hysterical dys- 
phagia, or in certain insane states, notably melancholia. Local 
disease may require local application of cautery, astringents, etc. 
By means of the proctoscope, enteroscope, or rectal specula, such 



44 A TEXT-BOOK OF MATERIA MEDIC A. 

topical applications may be made with ease and precision. Before 
making use of the rectal mucous membrane as a means for absorp- 
tion it should be cleaned thoroughly. The alkaline reaction of the 
mucus should be remembered in prescribing, else incompatibility 
may easily arise. Most drugs are absorbed much less rapidly 
through the rectal wall than through the stomach ; there are, how- 
ever, a few exceptions. These are notably strychnine, morphine, 
and iodine. Such is the teaching of many modern text-books. 
Personally, I have not been able to verify this. 

Enteroclysis, or intestinal hydrotherapy, as one author puts it, 
is a method of intestinal irrigation, including the use of enemata, 
used for the relief of a variety of conditions. It is a highly valu- 
able procedure. Any syringe will suffice, but for large quantities 
of water, the fountain or bag syringe is perhaps best adapted. 

Large quantities of fluid may be thrown into the bowel — as 
much as 9 pints may be used. If the temperature of the fluid is 
high, — ii5°-ii8°F., — there is less tendency to the development 
of intestinal cramps. When a large quantity of water is used to 
irrigate the bowel, its course may be followed by percussion, and 
its descent into the ascending colon noted. In this manner the 
cecum can be reached and thoroughly cleansed, a procedure of 
much value in the medical treatment of appendicular disorders. 
Normal salt solution may be used to subserve the same purposes 

>y hvpodermoclysis. 

Suppositories afford a simple method of medication for local or 
for general purposes. 

Nutrient Enemata may be employed when, for any reason, the 
food cannot be made either to enter the stomach or to remain 
there. Small quantities — 3 or 4 ounces — are retained better than 
larger amounts. As the mucous membrane of the rectum does not 
have any digestive power, such enemata should be predigested, 
either by peptic or pancreatic ferments. Milk, oatmeal gruel, 
Oysters, eggs and milk, peptonized, with mild alcoholic additions, 
afl of sherry, make excellent nutrient enem.it. 1. 

Urethra, — Here direct application, irrigation, and suppositories 

afford tlie best means of medication. The cystoscope may be used 

or for direct applications to the walls of the bladder. 

Stomach. — Medication by means < »f the stomach is the most 

;t and practical method. The passage through the mouth 

and esophagus does not alter, to any great extent, the principles of 



MODES OF INTRODUCTION OF REMEDIES. 45 

drugs. Some drugs, such as strong acids, must be well diluted 
in order to protect the mucous membrane of the mouth and the 
enamel of the teeth. The administration of certain of the metals 
requires caution. Thus, some of the soluble iron preparations alter 
the color of the teeth somewhat ; lead acts injuriously if the teeth 
are carious ; and when mercury is being administered, the hygiene 
of the mouth must be carefully watched. In the stomach many 
drugs that are insoluble or slightly soluble in water are rendered 
more soluble by the weak acids ; many chemical reactions take 
place, which are further complicated as the drugs pass into the 
intestines and meet the alkaline fluids, the bile salts, and the prod- 
ucts of intestinal digestion. 

Intravenous Injection may be resorted to in desperate cases : its 
dangers are obvious, however, and, save for the purpose of trans- 
fusion after severe hemorrhage, it can seldom be attempted with 
impunity. 

Internal Administration. — The most obvious, and by far the 
most useful, method of internal administration is by the mouth ; 
yet care and discretion are to be used even in so ordinary a process, 
and the physician should consider thoughtfully the time, consequent 
effects, and chemical changes, that the drug may produce the most 
beneficial results. 

Inhalation is in many respects of the first importance as a 
method of internal administration. Its great facility in practice 
and its unquestionable efficiency — as in the case of anesthetics — 
render it readily available and highly beneficial, although the 
method has attained as yet only a limited use in therapeutics 
beyond a resort to it in pulmonary diseases. 

Enemata. — A different class of administrative operations consists 
in injections into the rectum, which injections may be purgative, 
anodyne, nutrient, emollient, astringent, anthelmintic, etc. For 
speedy and efficient cleansing of the large intestine the purgative 
enema is of incomparable value, care being taken that the quantity 
of the injection be sufficient, that it be passed up as far as possible, 
and that it remain as long as the patient is able to retain it. 

Absorbable enemata are usually small in quantity ; they have 
proved useful in certain cases of diarrhea and dysentery, and are 
serviceable when the act of swallowing is precluded by affections 
of the esophagus or in cases where the stomach requires complete 
rest. The rectum, however, possessing no digestive capacity, the 



46 A TEXT-BOOK OF MA TERIA MEDICA. 

injection should consist of the simplest materials and contain pepsin 
and acid or pancreatic fluid. 

Another mode of securing beneficial results from internal admin- 
istration through the absorptive properties of the intestine is by 
means of suppositories, readily introduced within the sphincter ani 
and dissolving at the temperature of the body. 

To take the place of intravenous injection, normal solution, 0.6 
of I per cent., is used as an enema in all conditions where the 
former is indicated, especially after major operations. From 7 to 
17 fluidounces (207-503 Cc.) are injected, according to the indi- 
vidual tolerance of the patient. These injections are to be repeated, 
in the endeavor to secure the absorption of from 2 to 6 quarts 
(liters) of the solution in the course of twenty-four hours. 

Conditions Modifying the Action of Remedies. — All indi- 
viduals are not affected in the same degree by the same remedy. 
Age, size, weight, fatness or leanness, sex, temperament, etc., are 
some of the variants. These may be considered under the general 
head of dosage. 

Dosage. — The term dose implies the quantity of a medicinal 
agent which under certain conditions it is advisable to administer, 
many considerations entering into the question, to be weighed by 
the features of the individual case. Dosage may be regarded as 
perhaps the most vulnerable point in therapeutic science, yet one 
upon which the art of healing almost wholly depends. 

Since Heller in 1755 enunciated his philosophical maxims 
touching the rational method of testing the therapeutic effects of 
drugs, eminent clinicians have sought to solve the mysteries attend- 
ing the action of various remedies whose modus operandi remains 
to tins day obscure. Indeed, so great is the diversity of operation 
pertaining to the commonest remedies, conditioned by the character 
and circumstances of the case, as well as the amount and quality 
of the drug, that it is next to impossible to predicate the precise 
effects of agents whose physiological properties are theoretically 
and even practically established. The ordinary adult dose of 
opium, for instance, is 1 gr. (0.06 Gin.); yet in certain diseases, 
such , ten times that amount may be required to 

relieve the pain. The doses given in many text-books differ 
rially from those prescribed in actual practice, being in- 
■jpress only the average quantities to be admin- 
d, tlie exact amounts varying with the conditions of the 



MODES OF INTRODUCTION OF REMEDIES. 47 

particular case. These conditions may be classed under the 
heads of age, sex, temperament, idiosyncrasy, habit, state of the 
system, temperature of the body, time of administration, intervals 
between doses, cumulative action of the drug, and the contingent 
considerations of diet, climate, race, etc. — oftentimes a complicated 
problem even to the most skilful therapeutist. A few suggestions 
regarding the leading characteristics of dosage, as limited by these 
various circumstances, may be of value to the student. 

The influence exercised by Age is indubitable, as a rule the 
young requiring smaller doses than adults, the very aged may be 
also very susceptible. With regard to children several mathematical 
formulas have been devised, none of which, however, has proved 
infallible — least of all those based upon adult dosage, itself subject 
to no little uncertainty. Nor can deductions as to the efficacy of 
a given dose be drawn from the action of drugs with which the 
agent is naturally associated. A single drop of laudanum has been 
known to produce the death of an infant, whereas large doses of 
belladonna, conium, arsenic, and mercury have been taken with 
comparative impunity. 

The most convenient rule (Young's) adds 12 to the child's 
age and divides by the age to get a denominator of a fraction 
whose numerator is 1, this fraction representing the proportion 
between adult and infant doses. Thus, for a child three years old 
3+12 
— - — — 5, or \, the dose being one-fifth of that given to an adult. 

Temperament acts as an important agent in modifying the effect 
of medicinal remedies, phlegmatic subjects readily tolerating cer- 
tain medicines, such as opium, which those of nervous temperament 
are unable to bear. Stimuli act upon sanguineous patients forcibly, 
yet upon others their influence may be either tardy or ineffectual. 
The condition is one which discloses a wide field of inquiry, the 
mental, moral, and physical tendencies of the individual being 
involved in the practical administration of medicines. 

Closely allied to the foregoing is the question of Idiosyncrasy, the 
constitutional peculiarity which exerts a subtle influence, scarcely 
understood, as potent as it is obscure. Its characteristics cannot 
be formulated, but must be studied with the aid of experience — an 
odor, a taste, a casual or fixed impression, or hereditary instinct 
often determining their existence and manifestation. In tempera- 
ment and idiosyncrasy, indeed, the psychological rather than the 



48 A TEXT- BOOK OF MATERIA MEDIC A. 

physiological side of therapeutics is developed, requiring for its 
treatment a professional acumen not always at command. 

The influence of Habit is to diminish the susceptibility of the 
organism to impressions which under normal conditions would be 
speedy and effectual. Only by gradually increasing the quantity 
of the dose can results be obtained which in ordinary circumstances 
require few exhibitions. Thus, patients accustomed to the use of 
alcoholic stimulants accept heroic doses of alcohol with little or no 
indication of the effects quickly perceptible in temperate subjects. 

Bodily condition obviously affects the action of remedial agents. 
It is well established that in severe pain opium may be adminis- 
tered in quantities which in a healthy organism would produce 
untoward, perhaps fatal, results. The salivation occasionally caused 
by mercury is seldom apparent in febrile conditions. Yet in cases 
where sensibility is diminished great care is necessary to avoid the 
deleterious effects of over-stimulation or excessive dosage. 

Tolerance is closely associated with habit. There may be a 
specific tolerance of the nature of an immunity. Thus, rabbits are 
known to be very resistant to belladonna, hogs to snake venom, 
etc. Acquired tolerance is repeatedly seen for tobacco, alcohol, and 
opium, and certain recent studies have attempted to show that sub- 
stances related to immune bodies are elaborated by the organism, 
thus in part explaining the phenomena of acquired tolerance. 

Respecting Sex, although it is generally admitted that females 
require smaller doses than males, the exceptions to the rule are so 
numerous as almost to vitiate the accepted theory. 

The Time of Admi?iistration is closely connected with the Form 
of the Remedy given, as a rule remedies being withheld immedi- 
ately before and after meals. The practice, however, is subject 
to modifications, certain drugs acting best on an empty stomach, 
and others, such as local irritants, being more safely diffused when 
the stomach is full, in which case by mingling with the food they 
are not brought into irritating contact with the intestinal mucous 
membranes. 

With regard to Intervals between Doses it may be said, in brief, 

that they are to be determined by tile special features of the case, 
and potency of the drug, and the degree of tolerance 
and assimilation evidenced by the patient. Every remedial agent, 
under normal conditions, produces a specific and definite action, 
the lystem by absorption and elimination limiting the period of its 
>• in cases of prolonged treatment, so that the drug is evi- 



UNTO WARD EFFECTS OF DRUGS. 49 

dently to be renewed in order to secure perfect results. Failure to 
continue treatment has frequently proved disastrous, even fatal, to 
the patient, and it should be borne in mind that, in the absence of 
contraindications or untoward effects, a primary object of dosage is 
to create and maintain an impression upon the morbid system. 

Repeated dosage with tardy elimination may lead to cumulative 
action. Thus, while dose for dose ethyl alcohol is more toxic than 
methyl alcohol, repeated doses of methyl alcohol are more highly 
poisonous, from slow elimination, than doses of ethyl alcohol. The 
chronic poisoning by the heavy metals, arsenic, mercury, or lead, 
is an illustration of a type of cumulative action. The iodides 
and bromides show similar phenomena. Digitalis is a classical 
example. 

Other considerations — by some therapeutists held to be of mi- 
nor, by others of paramount, importance — affect the vital question 
of dosage. The emotions, for example, play an interesting part in 
the toleration or rejection of remedial agents. Strangely enough, 
too, the imaginative faculty is often a cause of idiosyncrasy, numer- 
ous instances being adduced by reputable authorities wherein 
either positive or fancied ills were affected through the agency of 
spurious remedies — bread-pills, deceptive concoctions, and the like 
— the ethical aspect of therapeutics being here left to the conscience 
of the physician. 

Pathological states are important modifiers of drug action. Thus, 
in chronic nephritis drugs which do not modify the kidney epithe- 
lium are used. Effort is made to obviate such activities. In high 
temperature the many synthetic antipyretics act very rapidly while 
having very little effect in health. In the case of parasitic diseases 
such as trypanosomiasis or malaria, the action of trypan-red or of 
quinine is naturally and entirely a different action than when given to 
a healthy person. In certain intestinal diseases associated with 
acid diarrhea, and with diminished alkalinity of the intestinal canal, 
the use of synthetic remedies which are only broken down into 
their constituent parts by alkalis is obviously useless. 



UNTOWARD EFFECTS OF DRUGS. 

Drugs given a specified patient, a victim of acquired or in- 
herited defect, will produce in that patient unexpected results dif- 
fering from their usual action. These results, which should not be 



50 A TEXT-BOOK OF MATERIA MEDICA. 

classified with typically poisonous effects or with those of pro- 
longed use, may not appear in many cases, and do not correspond, 
as a rule, with the admittedly poisonous symptoms. They have 
been termed in Germany " nebenwirkungen," in France " incon- 
venients therapeutiques," and among the English-speaking nations 
u untoward effects " and " bye-effects." 

Untoward effects are of great interest from a medico-legal 
standpoint. Even physicians are but too apt to refer them to 
defects or impurities in the drug dispensed. They are seemingly 
multiform in character, and yet they can readily be ranged under a 
few general laws. The primary and secondary effects, which are 
often opposite in nature, the organs chiefly affected by the ordinary 
action of the drug, the method of drug-excretion, all play a part in 
what may be called general constitutional untoward effects, as con- 
trasted with the untoward manifestations due to temporary and 
evanescent conditions, which last, however, also range themselves 
in a regulated fashion. 

Prediction may be made with considerable accuracy as to the 
untoward effects of any drug on learning its action and all the 
factors cited. An antipyretic will have as untoward effects, skin- 
eruption because it is excreted through the skin, because the skin 
through its pores regulates temperature, and hence is under control 
of the central nervous system regulating temperature, and, finally, 
because the skin is in close connection from an early period with 
the nervous system. For the same reason profuse, debilitating 
perspiration often results. Since control of the temperature cannot 
be effected without control of the vasomotor system regulating the 
blood-supply, heart-failure, collapse, and palpitation may result, 
together with certain eve- and ear-symptoms. 

The action on the heart may, by its influence on the kidney 
circulation, cause kidney and bladder symptoms even to the extent 
of albumin in the urine. If a remedy be excreted through the 
kidneys, albuminuria may present itself as an untoward result as is 
sometimes the ease with ether. Alteratives and purgatives produce 
hemorrhages from the mucous membranes and swelling of those 

of the organs of special sense, beside skin-eruptions. Some hyp- 
notic s produce excessive perspiration, skin eruptions, vertigo, and 
heart collapse. Astringents cause diarrhea and bloody intestinal 
discharges. Diaphoretics cause pains at certain points from over- 
stimulation. Pilocarpine causes at times pain in the penis; as there 
often occur in certain persons excessive secretion and plugged 



UNTO WARD EFFECTS OF DRUGS. 51 

sebaceous glands around its head, the pain and other resultant 
symptoms simulate chancre. 

It will be observed from the annexed tables (see pages 52-57) 
that the most potent tonics and alteratives are most fertile in 
untoward effects. This is naturally to be expected. A drug of 
potent physiological action must of necessity try more severely 
inherited and acquired deficiencies of constitution than an inert 
drug. Too excessive strain on inhibitions weakened by acquired 
or inherited taint gives an undue sway to inhibited centers. Un- 
toward effects of drugs may hence be conditioned on pre-existing 
affections of the inhibitory apparatus of the system. 

One influence which, together with hereditary or acquired 
defect, plays a part in determining untoward results is what 
the Germans call the " etiologic moment." This is excellently 
illustrated in the neurotics, which display such decidedly variable 
untoward effects. In many neuroses nerve-strain of the elimi- 
native and assimilative organs has produced toxins and other 
products ; some of these naturally add to the effects of a given 
neurotic drug, or direct these in some special channel or inhibit 
certain effects, thereby giving others undue play. This may con- 
stitute, as Lewin has shown, a disposition that is but temporary, 
which disposition may have its foundation either in a greater 
abundance in the system of bio-chemical substances, which cause 
an unusually prompt solution or action of the medicines intro- 
duced, or which may unite with them to form injurious com- 
pounds; or it may be conditional on pre-existing pathologic 
changes in the inhibitory apparatus of the system. 

The tables given on pages 52-57, covering all the departments 
of the materia medica, will give a better idea of these untoward 
effects than any detailed description. 



52 



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03 

03 

c 

03 

r7} 


<n 

'3 
cr 


^ o 
o1£ 

II- 



58 A TEXT-BOOK OF MATERIA MEDICA, 

CLASSIFICATION OF MEDICINES. 

The classification of drugs and remedial agents is a theme 
regarding which the many writers upon and teachers of medicine 
have shown a wider diversity of opinion, perhaps, than upon the 
physiological action and medical uses of individual remedies. The 
fact that therapeutics is far from being an exact science, and the 
rapid advance in our knowledge of normal physiological processes, 
of pathological conditions, and the systematic action of drugs, are 
sufficient explanation of the ever-changing judgments of our 
best observers concerning the action of certain medicinal agents 
under given conditions. 

It follows that from time to time, as appears in reviewing the 
literature of the subject, different writers, in their attempt to keep 
pace with the advancement of knowledge, have devised various 
systems of classification. 

In earlier days, when the therapeutist culled from the fields his 
simples for the cure of disease, there was naturally created a strong 
tendency toward a botanical classification. So far was the system 
pushed that in certain so-called schools of medicine the authority 
of Scripture was invoked, it being proclaimed as an axiom that 
" the leaves of the tree were for the healing of the nations " (Rev. 
xxii. 2). This eclecticism, strange as it may seem to-day, was the 
outgrowth of the Thompsonian or Botanical system of therapeutics. 
On the other hand, as an evolution of the old alchemic school, an 
attempt was made to found a classification by explaining the 
remedial action of all medicines upon a purely chemical basis. 

With the advent of more modern methods of study, applied to 
the physiological action of drugs upon the animal economy, came 
the physiological classification, in which the effects of remedial 
explained upon rational grounds. 

It is hardly necessary to state that coexistent with these various 
endeavors to attain a philosophical method of classification, com- 
ting them and perplexing their votaries, the dominating prin- 
ciple of empiricism held universal sway, setting at defiance in many 
rdinal maxims of rational therapeutics, the rational 
n to-day welcoming as a last resort the cruder 

though often efficient, empirical method 

author^, perceiving the inutility of the older systems, 

ntented themselves with a mere alphabetical arrangement 



WEIGHTS AND MEASURES. 59 

of medicinal agents, regardless of their origin, natural affinities, 
mode of preparation, and physiological action. 

Taking all the conditions into consideration, it seems the wisest 
plan for beginning students of medicine to so arrange the various 
drugs in use as far as possible along lines of therapeutic efficiency ; 
and inasmuch as the trend of modern therapeutics is becoming more 
and more physiological, a combination of the physiological and 
therapeutic systems is here adopted. Many inconsistencies are 
inevitable in any classification, yet such a method of grouping is 
deemed the most satisfactory for students and practitioners alike. 



WEIGHTS AND MEASURES. 

The history of Weights and Measures affords a striking example 
of the incongruity resulting from the absence of a uniform standard 
of stable value to science, and must be regarded as the strongest 
argument in favor of the Metric, or Decimal, System. 

An idea of the confusion prevailing under the old methods may 
be gained from an examination of their comparative units, by which 
we find that a pint is not a pound, an ounce not equal to a fluid- 
ounce, a drachm not equivalent to a fluidrachm, and a minim not 
commensurate with a grain. It was not until 1836 that the Secre- 
tary of the U. S. Treasury was directed by Congress to furnish each 
State in the Union with a complete set of revised standards, includ- 
ing the troy pound of 5760 grains, from which the Apothecaries', 
or Troy, weight is derived, the latter term at present being applied 
only to the system used in weighing precious metals. 

For commercial purposes the following Weights and Measures 
are employed : 

Avoirdupois Weights : the Pound divided into 16 Ounces. 

Liquid Measures : the "Wine Measure," of which the U. S. 
Gallon represents a volume of 231 cubic inches; each cubic inch 
of water at the maximum density (4 C.) being equivalent to 
252.892 grains, the weight of a Gallon being therefore 58,418 
grains. The Gallon is divided into 8 Pints (octarius), and the Pint 
is divided into 16 Fluidounces, each containing 8 Fluidrachms, 
or 480 Minims, the Fluidrachm containing 60 Minims. The signs 
used to designate these units are — TTL, denoting minim or minims ; 
f 3, fluidrachm or fluidrachms ; and f %, fluidounce or fluidounces. 



60 A TEXT-BOOK OF MATERIA MEDICA. 

Apothecaries' (Troy) Weight. 

20 grains (gr. granum) = I scruple d (scrupulum). 

60 grains, or 3 scruples = I drachm 3 (drachma). 

480 grains, or 8 drachms = I ounce 5 (uncta). 

5,760 grains, or 12 ounces = I pound ft) {libra). 

Apothecaries' (Wine) Measure. 

60 minims (m) = I fluidrachm f 3. 

480 minims, or 8 fluidrachms = 1 fluidounce 13. 
7,680 minims, or 16 fluidounces = I pint (pctarius). 
61,440 minims, or 8 pints = I gallon C (congius). 

This lack of uniformity in the units and the denominations of 
the three systems of weights and measures is exemplified in the 
subjoined table. While the two weight systems have a unit in 
common, the grain, there is no correlation in the higher denomina- 
tions, ounces and pounds. The desirability of adopting a fixed 
standard, applicable in all cases where great accuracy in weights 
and measures is requisite, has been frequently emphasized by 
writers on therapeutics. As we have premised, the present diffi- 
culty forms a cogent argument in favor of the metric system, as 
wisely adopted in the U. S. Pharmacopoeia. A remarkable dis- 
parity is shown in the liquid measures, in which there is no unit 
in common : a minim is not a grain, nor " a pint a pound the world 

around." 

Illustrations. 

I ounce, avoirdupois, = 

1 ounce, troy or apothecaries', = 

I fluidounce of water (the standard of volume) = 
1 pound, avoirdupois, = 

1 pound, troy or apothecaries', 

1 minim of water weighing 4 .,Vu 7 = 

1 g rains of water = 

(In the metric system, as seen below, there is but one group of 

and these bear a definite relation to volume; for one cubic 

' r of water, the standard of volume, weighs exactly one 

1.) 



437-5 


grains. 


480 


grains. 


4557 


grains. 


7000 


grains. 


5760 


grains. 


0.95 grains. 


16 


minims 



'I III Mil l;l< SYSTEM. 



tem of Weights and Measures, destined to sup- 

originated with Prince de Talleyrand, bishop of 



WEIGHTS AND MEASURES. 6 1 

Autun, in 1790. Its almost universal adoption by civilized nations, 
its legality, though not compulsion, in England and the United 
States, and its adoption by the U. S. Pharmacopoeia of 1890, 
require that it should be understood alike by the physician and 
the druggist. Save in the English-speaking world it is the only 
system used for governmental, statistical, and scientific purposes, 
and in the arts and manufactures its value has long since been 
recognized. Its extreme simplicity, its uniformity, and its facility of 
computation render it far superior to any other system of Weights 
and Measures, and it is highly probable that in the near future it 
will prevail in the transactions of every-day life, as it has already 
acquired international importance, and is in fact referred to as the 
International System. 

The starting-point is the unit of length, the meter {metre), which 
is the 50T0V0 o"TT P art °f tne eartn ' s circumference around the poles. 
From this apparently irrelevant measure of length the unit of 
capacity, or volume, the liter, was established, it being the cube of 
-^ of a meter. With equal simplicity and clearness, from the meter 
was derived the unit of weight, the gramme, which is the weight 
of that quantity of pure water at the maximum density, 4 C. 
(39.2 F.), which will fill the cube of yj-g- part of a meter (cubic 
centimeter). 

The Metric is also known as the Decimal System, because its 
multiples and subdivisions are obtained by ten (Lat. decern). The 
prefixes denoting multiplication are of Greek derivation, and are 
usually spelled with a capital letter: Deka 10, Hecto 100, Kilo 
1000, Myria 10,000. Division of the units is indicated by Latin pre- 
fixes, not capitalized : deci y^-, centi yj-g-, milli ywqo- To distinguish 
readily one process from the other the word GILD has been aptly 
suggested as a mnemonic : 

GILD. 

Greek increases, Latin decreases. 

Contrary to a prevalent opinion, the Metric System is easily 
mastered. A perfect acquaintance with the metric tables is, nat- 
urally, indispensable, and the abbreviations for the different weights 
and measures should be thoroughly at command. For the rest, 
the system is simply that of arithmetical decimals, requiring chiefly 
a correct use of the decimal point. Only a tyro would read .065 
six and five-tenths hundredths instead of sixty-five thousandths ; so 



62 A TEXT-BOOK OF MATERIA MEDICA. 

Gm. .065 would never be read by one acquainted with decimals 
six centigrams and five milligrams, but sixty-five milligrams. 

Metric Table of Lengths. 

The measures of length employed in prescription writing are the 
millimeter, centimeter, decimeter, and meter. 

10 millimeters make I centimeter. 

10 centimeters " I decimeter. 

10 decimeters " 1 Meter. 

1 millimeter is written 1 mm., or M .001, equal in inches to .039370432, approx. J3- 
1 centimeter " 1 cm., " M .01, " " -39370432, " •§. 

1 decimeter " 1 dm., "M.I, " " 3-937°432, " 4. 

1 Meter " 1 M., " M I., " " 39-370432, " 40. 

Metric Table of Capacities. 
The only measures of capacity employed in prescription writing 
are the cubic centimeter and the liter. iooo cubic centimeters 
(Ccm. or Cc.) make I Liter (L.). 

Metric Table of Weights. 

The weights employed in prescription writing are the milligram, 
centigram, decigram, gram, and kilogram. The other terms in the 
following table are but rarely employed abroad and never among 
English-speaking physicians. It will be seen that one Kilogram 
represents 1000 Grams. 

10 milligrams make 1 centigram. 

10 centigrams " 1 decigram. 

10 decigrams " 1 Gram. 

10 Grams 1 Dekagram. 

10 Dekagrams " 1 Hectogram. 

10 Hectograms " I Kilogram. 

10 Kiln<; nuns " 1 Myriagram. 

Abbreviations for the different divisions and multiples of the 
Gram, with their corresponding equivalents in grains, are as follows : 

ligram i- irritten 1 mg., 01 Gm .001, equal in grains to (,,', ) .015432 
1 entignm " 1 1 g., " < rm. ,01 " " (J) -15432 

1 '!•/.. •* < .in. .1, " " 1-5432 

1 Gi " 1 ( rm. , " ( rm. 1. 1 " " 15.432 






WEIGHTS AND MEASURES. 



63 



In writing prescriptions a physician uses but one system, the 
metric or the apothecaries' ; therefore to write prescriptions properly 
he does not need to know how to convert from one system to the 
other. He learns one system and adheres to that. 

But to read and understand prescriptions written or spoken in 
the system other than the one he employs, he must translate them 
into his own system, and this requires a knowledge of equivalents. 
Knowing the approximate equivalents, it is then merely a matter of 
multiplication or division to convert a prescription of one system 
into a prescription of the other system. 

Examples of conversion are : 

1 milligram — ^ grain : 5 milligrams = -fa = ^ grain. 

1 grain = 0.065 Gm., therefore 2 grains = 2 X 0.065 Gm. 

= 0.13 Gm., and t ^-q grain = y^- X 0.065 Gm. 
= 0.00065 Gm., etc. 

1 ounce = 30.0 Gm. : 4 ounces = 30.0 X 4 = 120.0 Gm. 



The Approximate and Exact Equivalents of Weights, Measures, and 
Lengths in the Two Systems. 



Weights — 


Approximate. 


Exact. 


1 milligram, o.ooi (mg.). 


£0 or <nr S rain - 


0.0154 grain. 


1 centigram, o.oi (eg.). 


1 or 1° grain. 


0.1543 grain. 


I decigram, o.i (dg.). 


ii grains. 


1-5432 


! grains. 


I gram, i.o (Gm.). 


15 grains. 


i5-43 2 4 grains. 


30 grams, 30.0 (Gm.). 


1 ounce. 


462.9 


grains. 


31 grams. 1 ounce Troy or 480 grains. 


478.4 


grains. 


I grain (gr. j). 


0.065 or 0.06 Gm. 


0.065 


Gm. 


10 grains (gr. x). 


0.65 or 0.7 Gm. 


0.648 


Gm. 


15 grains (gr. xv). 


1.0 Gm. 


0.972 


Gm. 


1 scruple (gj). 


1.3 Gm. 


1.296 


Gm. 


I dram (33). 


4 Gm. 


3-89 


Gm. 


1 ounce, troy (^j). 


30 or 31 Gm. 


311 


Gm. 


1 ounce, avoirdupois (oz.). 


28 Gm. 


28.35 


Gm. 


Measures — 








1 cubic centimeter (c.c). 


15 minims. 


16.23 


minims. 


1 liter (1000 c.c). 


34 ounces. 


33-8 


Cc. 


1 minim (Tl\). 


0.06 Cc.^ 


0.061 


Cc. 


I fluidram (fgj). 


4 Cc. 


3.696 


Cc. 


I fluidounce (f ^j). 


30 Cc. 


29-57 


Cc. 


1 pint (Oj). 


480 Cc. 


473-iS 


Cc. 


Lengths — 








1 meter (m.). 


40 inches. 


39-37 


inches. 


1 decimeter (dm.). 


4 inches. 


3-937 


inches. 


1 centimeter (cm.). 


0.4 or | inch. 


0-3937 


inch. 


1 inch. 


2.5 cm. 


2-54 


centimeters, 



64 A TEXT-BOOK OF MATERIA MEDICA. 

As these equivalents are only approximate, it is well to learn 
the foregoing " Table of Equivalents " and to avoid multiplying the 
equivalent of any term by too large a factor, for this likewise mul- 
tiplies the error. For example : 6 centigrams are approximately 
I grain, but 60 grains are not 360 ce?itigrai?is y the error for the 
equivalent of 1 grain being multiplied sixty times ; 60 grains are 1 
dram, and the approximate equivalent of 1 dram is 4 grams or 4.00 
centigrams, a much larger figure. 

N. B. — It is perfectly legitimate for a physician to use approxi- 
mate equivalents, for in using equivalents he is merely translating, 
for his own understanding, prescriptions which have been already 
written. A pharmacist should not need to translate at all, because 
he should have at hand both the metric and apothecaries' weights 
and measures, and use whichever the prescription calls for. 



PHARMACEUTICAL PREPARATIONS. 

Preparations made by the pharmacist are called pharmaceutical 
preparations. Nearly one-half of the articles of the United States 
Pharmacopoeia are pharmaceutical ; formulas being given for their 
preparation, they are intended to be made in the pharmacy. 
The commonly employed medical formularies are : 
The Pharmacopoeia (pharmahon, drug ; poieiu, to make), a book 
compiled by the government, or, as in" the United States, a National 
Committee on Revision, and published by authority, establishing 
standards for the identification, purity, strength, and quality, and 
giving directions for the purification, valuation, preparation, com- 
pounding, and preservation of drugs, chemicals, and medicinal 
preparations. The United States Pharmacopoeia is revised decen- 
nially, the present (eighth decennial revision) having become official 
on Sept. 1, 1 905. 

( U/'u !<i!{\a\{. officium, authority) drugs and preparations are those 
which are included in the Pharmacopoeia — all others are unofficial. 
nidi [ Pat. officina % a shop) was formerly applied to any 
dnij Ognized standard, but is now little used. 

National Formulary y a work published under the direction 

of the American Pharmaceutical Association, and designed to 

the formulae of such much-employed preparations as 

included in the Y . S. Pharmacopoeia. 

/; are compilations and commentaries on 

•harmacopoeias, and include the medical, physical, and chem- 



PHARMACEUTICAL PREPARATIONS. 65 

ical history and nature of the various substances, directions regard- 
ing dosage and administration, and observations on their physio- 
logical action and therapeutics. They also contain information 
concerning drugs not accepted by pharmacopceial authority, yet 
which are of occasional use or interest. The Dispensatory is in 
effect a private publication and unofficial, in this respect differing 
essentially from a pharmacopoeia. There are in the United States 
various works of this character, the United States and National 
Dispensatories being commonly in use. 

The following are the abbreviations used to indicate which of 
these is the authority for any given formula, or which formula is 
intended when more than one go by the same name : 
U. S. P. — United States Pharmacopoeia. 
B. P. — British Pharmacopoeia. 
P. G. — German Pharmacopoeia. 
N. F. — National Formulary. 
U. S. D. — United States Dispensatory. 
N. S. D. — National Standard Dispensatory. 

The pharmaceutical preparations may be divided as follows : 

I. Solutions. 
II. Liquid Mixtures — Internal. 

III. Extractive Preparations — Liquid and Solid. 

IV. Mixtures of Solids — Internal. 

V. Mixtures for External Use — Liquids and Solids. 

These groups are each divided into a number of Classes, each 
class having a distinct Latin title by which its members, or indi- 
vidual preparations, are officially designated and alphabetically 
arranged in the U. S. P. In addition to the Latin and English 
titles, each class is also known by an English name, besides various 
synonyms. There are altogether 34 of these Classes official, 
besides a number unofficial. official 

number. 

I. The Solutions are divided, according to the charac- 
ter of the solvent, into — 

Aqueous: Aquae — Waters . . 19 

Liquores — Liquors (solutions proper) 25 

Alcoholic: Spiritus — Spirits 20 

Elixiria — Elixirs 3 

Vina — Wines (by solution) 3 

5 



66 A TEXT-BOOK OF MATERIA MEDICA. 

Official number. 

Saccharine: Syrupi — Syrups 29 

Mellita — Honeys 3 

Glycerin : Glycerita — Glycerites 6 

II. The Liquid Mixtures — Internal : 

Misturae — Mixtures (proper) 4 

Emulsa — Emulsions 6 

III. Extractive Preparations : 

Liquid : 

Aqueous: Mucilagines — Mucilages 4 

Infusa — Infusions 3 

Decocta — Decoctions o 

Acetous : Aceta — Vinegars . . 2 

Vinous: Vina — Wines 7 

Alcoholic: Tincturae — Tinctures 63 

Fluidextracta — Fluidextracts 85 

Solid : 

Alcoholic: Extracta — Extracts 28 

Resinae — Resins 3 

Semi-liquid : 

Ethereal: Oleoresinae — Oleoresins 6 

IV. Mixtures of Solids — Internal : 

Pulveres — Powders 9 

Trituratio — Trituration I 

Sales effervescentes — Salts, effervescent .... 4 

Confectiones — Confections 2 

Trochisci — Troches 9 

Massae — Masses 2 

Pilulae — Pills 14 

V. Mixtures of Solids — External : 

Liquid : Linimenta — Liniments 8 

Oleata — Oleates 5 

Collodia — Collodions 4 

Solid: Unguenta — Ointments 24 

Cerata — Cerates 6 

Suppositoria — Suppositories I 

Emplastra — Plasters 7 

Charts — Papers I 



PHARMACEUTICAL PREPARATIONS, 67 

AQLLE MEDICATE— MEDICATED WATERS. 

The Medicated Waters are solutions of volatile substances in 
Water. They comprise (1) the Aromatic Waters and (2) the 
Chemical Waters. 

The Aromatic Waters are made by dissolving the volatile oils 
of their respective drugs, or distilling the latter with Water ; two 
Waters are saturated solutions of other liquids than volatile oils— viz. 
Aqua Chloroformi and Aqua Creosoti. The following are official : 

Contains Cc. in 100 Cc, 
Aqua — or percentage by volume. 

Amygdalae Amarae bitter almond oil o.I 

Anisi anise oil 0.2 

Aurantii Florum Fortior saturated 

Aurantii Florum of the above 50. 

Camphorae , . camphor 0.8 

Chloroformi 1 saturated 

Cinnamomi ............. cinnamon oil 0.2 

Creosoti creosote 1. 

Foeniculi ............... fennel oil 0.2 

Hamamelidis ......... made by distillation 

Menthae Piperitae . . . . . . . . . peppermint oil 0.2 

Menthae Viridis ........... spearmint oil 0.2 

Rosae Fortior saturated 

Rosae of the above 50. 

The Chemical Waters are solutions of gases in Water. The fol- 
lowing are official : 

Contains gas, percent- 
Aqua — age by weight. 

Ammonias . , NH 3 10 

Ammoniae Fortior NH 3 28 

Hydrogenii Dioxidi (Hydrogen Peroxide) . . . H 2 2 3. 

LIQUORES— SOLUTIONS. 

The Solutions (also termed Solutio, -nes, Lat.) are solutions of 
non-volatile substances in Water. 

The official Solutions are all solutions of inorganic salts. They 
are made either by simple solution (dissolving the particular salt in 

1 Chloroform Water, aside from its medicinal properties, is an efficient preservative 
agent, and forms a good solvent in place of water for preparing solutions intended to be 
kept free from micro-organisms, as, for example, those for hypodermic use. 



68 A TEXT-BOOK OF MATERIA MEDICA. 

Water) or by chemical solution (reacting upon different substances, 
and obtaining the newly-formed salt in solution in the Water). The 
following are official : 

The Arsenic Solutions: these are all of the same strength — 
viz. i per cent. ; 3 minims (0.2 Cc.) represent -^ grain (0.002 Gm.) 
of arsenic, the average dose: 

Percentage 
Liquor — or Gm. in 100 Cc. 

Acidi Arsenosi acid, arsenous 1. 

Arseni et Hydrargyri Iodidi arsenic iodide I. 

(Donovan's Solution). mercuric iodide I. 

Potassii Arsenitis . . potas. bicarb. 2 ; arsenic trioxide I. 

(Fowler's Solution) comp. tinct. lavender 3. 

Sodii Arsenatis sodium arsenate I. 

The Alkaline Salt Solutions, prepared by saturating an organic 
acid with an alkaline carbonate or bicarbonate, furnishing an agree- 
able and refreshing potion (also designated Saturatio, Potio, Lat.) 
charged with Carbonic Acid Gas. The dose is from 2 to 4 fluid- 
drachms (8-15 Cc), except Liq. Magnesiae Citratis: 

Liquor — Gm. in 100 Cc. 

Ammonii Acetatis (Spiritus Mindererus) ammon. carb. 5. 

acid, acetic, dil. 100. 

Magnesii Citratis . . . magnes. carb. 15.; acid, citric. 33. 

potas. bicarb. 2.5 ; syrup, 

acid, citric. 60 Cc; aqua ad 350. 

Potassii Citratis (Neutral Mixture) . . potass, bicarb. 8. 

acid, citric 6.; aqua ad 100. 

The Iron Solutions, containing ferric salts in the following pro- 
portions by weight : 

Gm. in /oo, or 
Liquor percentage by weight. 

IVrri Chloridi ferric chloride 29. 

Fcrri et Ammonii Acetatis . . . liquor ammon. acet. 50. 

ham's Mixture), acid, acetic, dil. 6; tr.ferri chlor. 4. 

elix. arom. 12; glycerin 12; aqua ad 100. 
Fcrri Subsulphatis (Monsel's) . . . ferric subsulphate 

13.57 per cent, of metallic Fe 

Itis ferric sulphate 36. 



PHARMACEUTICAL PREPARATIONS. 69 

The Alkali Solutions : 

Percentage by vol. 
Liquor— or we i g ht, 

Calcis (Lime Water) calcium hydroxide 0.14 

Potassii Hydroxidi potassium hydroxide 6. 

Sodii Hydroxidi sodium hydroxide 5.6 

Sodae Chlorinatae (Labarraque's) chlorine 2.4 

The Solutions of Metallic Compounds ; used only externally : 

Percentage by vol. 
Liquor— or we i gn t. 

Hydrargyri Nitratis mercuric nitrate 60. 

Plumbi Subacetatis . lead subacetate 25. 

Plumbi Subacetatis Dilutus .... of above solution 4. 

(Lead Water) distilled water to 100. 

Zinci Chloridi zinc chloride 50. 

The Antiseptic Solutions : 

Percentage by vol. 
Liquor— or we i g ht. 

Antisepticus . boric acid 2; benzoic acid 0.1 ; thymol 
0.1 ; eucalyptol 0.025 ; oil of peppermint 
0.05 ; oil of gaultheria 0.025 ; oil of 
thyme 0.0 1 ; alcohol 25. ; purified talc 2. 

Chlori Compositus chlorine 0.4 

Cresolis Compositus cresol 50. 

Formaldehydi formaldehyde 37. 

Also, 

Liquor Iodi Compositus (Lugol's Solution) 

potass, iodid. 10; iodine 5. 

Liquor Sodii Phosphatis Compositus . sodium phosphate 100. 

Unofficial Liquors of the National Formulary. 
Liquor — 

Acidi Phosphorici Compositus (Acid Phosphates). 

Alumini Acetatis (Alumini Acetici, Ph. Ger.). — Contains 8 

per cent, of basic Aluminum Acetate. 

Alumini Acetico-tartratis. — Contains about 50 per cent. 

of dry, so-called Aluminum Acetico-tartrate, which may 

be obtained by evaporating the solution. 
Auri et Arseni Bromidi. — Ten minims contain -£% grain 

(0.002 Gm.) of Tribromide of Gold and ^ grain (0.004 Gm). 

of Tribromide of Arsenic. 



70 A TEXT-BOOK OF MATERIA MEDICA. 

Liquor — 

Bismuthi. — Each fluidram (4 Cc.) represents 1 grain (0.06 

Gm.) Bismuth and Ammonium Citrate. 
Bromi (Smith's Solution of Bromine). — Bromine, 20 per cent; 

Potassium Bromide, 10 per cent.; Water. 
Calcis Sulphurate (Solution of Oxysulphuret of Calcium ; 

Vlemingkx's Solution or Lotion). 
Cupri Alkalinus (Fehling's Solution). 

I. The Copper Solution. 

Copper Sulphate, pure grains 505 . . 34,639 Gm. 

Distilled Water . . enough to make fluidounces 16 . . 500 Cc. 
II. The Alkaline Solution. 

Potassium and Sodium Tartrate . . grains 252 . . 173 Gm. 

Soda (U. S. P.) troy ounces 2 . . 60 Gm. 

Distilled Water . . enough to make fluidounces 16 . . 500 Cc. 

Keep both solutions, separately, in small well-stoppered vials, in a cool and 
dark place. For use, mix exactly equal volumes of both solutions by pouring 
the copper solution into the alkaline solution. Ten Cc. of the mixture prepared 
by metric weight and measure correspond to 0.05 Gm. of glucose. Of the mix- 
ture prepared by apothecaries' weight and measure, 210 minims correspond to 
I grain of glucose. 

Electropoeicus (Battery-fluid). 

A. For the Carbon and Zinc Battery. — I. (For ordinary use). — Potassium Bi- 
chromate, in powder, 6 troy ounces (180 Gm.) ; Sulphuric Acid, commercial, 
6 fluidounces (180 Cc.) ; Water, cold, 48 fluidounces (1400 Cc). — II. (For use 
with the galvano-cautery). — Sodium Bichromate, in powder, d]/ 2 troy ounces 
(185 Gm.); Sulphuric Acid, commercial, 14 fluidounces (420 Cc); Water, 
cold, 48 fluidounces (1400 Cc). 

Pour the Sulphuric Acid upon the powdered Bichromate and stir the mix- 
ture occasionally during one hour. Then slowly add the Water. Sodium Bi- 
chromate is more soluble than the Potassium Salt, and also much cheaper. 
When it cannot be obtained, the Potassium Salt may be substituted for it, 
nreight for weight. 

\\. For the Leclancht: Battery. — Ammonium Chloride, 6 troy ounces (180 
X}m.) ; Water, enough to make 20 fluidounces (600 Cc.) ; dissolve the Salt in 
the Water. 

Ferri OxYSULPHATIS (Oxysulphate of Iron). 

Ferri PROTOCHLORID1 (Solution of Ferrous Chloride). — Each 
fluidrachm (4 Cc.) represents about 20 grains (1.3 Gm.) of 
Protochlofide of Iron (ferrous chloride). 

HydrarGYR] ET POTASSIl IODIDl (Solution of Iodide of Mer- 
cury and Potassium ; Channing's Solution). — Red Mercuric 
Iodide, 72 grains (5.0 Gm.); Potassium Iodide, 56 grains 
(3.8 Gm.); in Distilled Water, 16 fluidounces (450 Cc). 



PHARMA CEUTICAL PRE PAR A TIONS. 7 1 

Liquor — 

Hypophosphitum. — Each fluidraehm (4 Cc.) contains 2 grains 
(0.12 Gm.) of Calcium Hypophosphite, I \ grains (0.75 Gm.) 
of Sodium Hypophosphite, and 1 grain (0.06 Gm.) of Po- 
tassium Hypophosphite. 

Iodi Carbolatus (Boulton's Solution ; " French Mixture "). — 
Comp. Tincture of Iodine, no minims (7 Cc.) ; Carbolic 
Acid, 40 grains (3.0 Gm.) ; Glycerin, 2\ fluidounces (100.0 
Cc); in 16 fluidounces (450 Cc). 

Iodi Causticus (Iodine Caustic ; Churchill's Iodine Caustic). 
— Iodine, I troy ounce (3 1 Gm.) ; Potassium Iodide, 2 troy 
ounces (63 Gm.) ; in Water, 4 fluidounces (120 Cc). 

Magnesii Bromidi. — Each fluidounce (30 Cc) contains about 
7 grains (0.5 Gm.) of Magnesium Bromide. 

MoRPHiNiE Citratis. — Each fluidraehm (4 Cc.) contains 2 
grains (0.12 Gm.) of Morphine in the form of citrate. 

Morphine Hypodermicus (Magendie's Solution of Morphine). 1 
— 1 6 grains ( 1 Gm.) Morphine Sulphate to 1 fluidounce (30 Cc). 

Pancreaticus (Pancreatic Solution). — Each fluidraehm (4 Cc.) 
represents 1 grain (0.06 Gm.) of Pancreatin, effectually pre- 
served in Glycerin and a little Alcohol. 

Pepsini Aromaticus. — Each fluidraehm (4 Cc.) represents 
1 grain (0.06 Gm.) of Pepsin. 

Phosphori (Thompson's Solution of Phosphorus). — Each fluid- 
drachm (4 Cc.) contains about -^ grain (0.0025 Gm.) of 
Phosphorus, preserved in Absolute Alcohol and Glycerin. 

Picis Alkalinus (Tar, Alkaline). 

Potass,e Chlorate (Solution of Chlorinated Potassa ; Javelle 
Water). — An effective and popular disinfectant. 

Potassii Arsenatis et Bromidi (Liquor Arsenii Bromidi ; 
Clemens' Solution). — This solution contains an amount of 
Arsenic in combination corresponding to about 1 per cent, 
of Arsenous Acid. 

The title " Solution of Bromide of Arsenic " (Liquor Arsenii Bromidi), which 
is often applied to Clemens' Solution or similar preparation, is a misnomer, 
since bromide of arsenic cannot exist, as such, in presence of water, but is 
split up into hydrobromic and arsenous acids. The proportions of the ingre- 
dients, in the formula above given, have been adjusted as closely as practicable, 
so as to yield definite compounds — viz. arsenate and bromide of potassium. 

1 Particular care should be taken in prescribing and dispensing this solution, so that 
it may not be mistaken for the so-called United States Solution of Morphine (Liquor 
Morphise Sulphatis, U. S. P. 1870), containing only I grain of Sulphate of Morphine 
in each fluidounce, which is still occasionally used. 



72 A TEXT-BOOK OF MA TERIA MEDICA. 

Liquor — 

SACCHARIN! (Solution of Saccharin). — Each fluidram repre- 
sents 4 grains of Saccharin. 

Intended to be used for sweetening liquids and solids when the use 
of sugar is objectionable, or when a sweet taste is to be imparted to a liquid 
without increasing its density. 

Seriparus (Liquid Rennet). 

If this liquid is to be used merely for curdling milk, without separating the 
whey as a distinct layer, it should be added to the milk, previously warmed 
to a temperature of about 35 C. (95°F.), and the mixture should then be set 
aside undisturbed until it coagulates. If the whey is to be separated, the 
Liquid Rennet should be added to the milk while cold, and the mixture 
heated to about 35 C. (95 F.), but not exceeding 40 C. (104 F.). One part 
of the liquid should coagulate between 200 and 300 parts of cows' milk. 

Liquor Sodii Arsenatis, Pearson. — This Solution contains 
about -fa per cent, of anhydrous Sodium Arsenate. 

This preparation should not be confounded with the Liquor Sodii Arsenatis 
of the U. S. P., which is ten times stronger than the above. Pearson's Solu- 
tion is official in the French Pharmacopoeia, under the title Solute d'Arse- 
niate de Soude (or Solution Arsenicale de Pearson). 

Sodii Boratis Compositus (Dobell's Solution). — Sodium 
Borate and Sodium Bicarbonate, each 120 grains (8.0 Gm.); 
Carbolic Acid, 24 grains (1.5 Gm.) ; Glycerin, - 1 fluidounce 
(15 Cc.) ; in Water, 16 fluidounces (450 Cc). 

Sodii Carbolatis (Phenol Sodique). — Carbolic Acid, 50 per 
cent. ; Soda, 3 per cent. ; in Water. 

Sodii Citratis. — Saturatio (Potio Riveri, Ph. Ger.). — Citric 
Acid, 150 grains (10.0 Gm.) ; Sodium Bicarbonate, 190 
grains (12.5 Gm.) ; in Water, 16 fluidounces (450 Cc). 

Sodii Citro-tartratis (Effervescing Saline Water). — Sodium 
Bicarbonate, Tartaric Acid, Citric Acid, Syrup, and Water, 
in about the same proportions as in Solution of Magnesium 
Citrate, for which it is a cheaper substitute. 

Sodii OLEATIS (Oleate of Sodium). — Intended to be used in 
the preparation of oleatcs. 

Strychnin.*: ACETATIS (Hall's Solution of Strychnine). — Each 
fluidrachm (4 Cc.) contains J grain (0.008 Gm.) Strychnine 
Acetate. 

The I'll. P<r. directs ■ Liquor Strychnine I Ivdrochloratis (with synonym, 
LiqOOf Strv< Inii.i 1 which is much Stronger, and should not be confounded 
with the above preparation. It should never be dis]>ensed unless expressly 
■ d. 



PHARMACEUTICAL PREPARATIONS. 73 

Liquor — 

Zinci et Ferri Compositus (Deodorant Solution). — A com- 
bination of Sulphates of Zinc and Iron, Naphthol, Oil of 
Thyme, and Hypophosphorous Acid, in Water. 

Used as a simple deodorant and antiseptic for common domestic use when 
it is unnecessary or impracticable to employ more powerful agents. 

When a deodorant solution is required for purposes where iron is objection- 
able — as, for instance, when woven fabrics are to be steeped in it— the follow- 
ing preparation may be employed : 

Liquor Zinci et Alumini Compositus, in which the Iron Sulphate is replaced 
by Aluminum Sulphate. 

Zingiberis (Essence of Ginger). — A 25 per cent, preparation 
of Ginger for flavoring aqueous mixtures. 

SPIRITUS— SPIRITS. 

The Spirits are solutions of volatile substances in Alcohol. 
They comprise (1) the Distilled Spirits; (2) the Aromatic Spirits, 
or so-called " Essences " ; and (3) the Medicinal Spirits. 
The Distilled Spirits are : 

Spiritus Frumenti (Whiskey), containing Alcohol 44-55 per 

cent, by volume. 
Spiritus Vini Gallici (Brandy), containing Alcohol 46-55 per 
cent, by volume. 

The Aromatic Spirits are made by dissolving the respective oils 
or aromatic principles in Alcohol : 

Cc. in 100 Cc, 
Spiritus — or percentage by vol. 

Amygdalae Amarae (water 19) . . bitter almond oil 1. 

Anisi anise oil 10. 

Aurantii Comp oil of orange peel 20. 

oils, anise 0.5 ; coriander 2 ; lemon 5. 

Camphorae camphor 10. 

Cinnamomi cinnamon oil 10. 

Gaultheriae wintergreen oil 5. 

Juniperi juniper oil 5. 

Juniperi Compositus . oil of juniper 0.4; oil of cara- 
way 0.05 ; oil of fennel 0.05 ; 

alcohol 70; water to make 100. 

Lavandulae . lavender oil 5. 

Menthae Piperitae peppermint herb 1 ; oil 10. 

Menthae Viridis spearmint herb 1 ; oil 10. 

These are chiefly used for flavoring purposes ; some are used 



74 A TEXT-BOOK OF MA TERIA MEDICA. 

medicinally as aromatic stimulants and carminatives in doses of 
from 15-30 minims (1-2 Cc.) ; Spiritus Amygdalae Amarae con- 
tains Hydrocyanic Acid, and is never used internally except in 
very small quantities as a flavor. 

The Medicinal Spirits are made by solutions of the medicinal 
substance in Alcohol. 

The following are official : „ . „ 

& Cc. in 100 Cc, 

Spiritus — or percentage by vol. 

Athens ether (C 2 H 5 ) 2 32.5 

Athens Comp. (Hoffmann's Anodyne) . ethereal oil 2.5 

ether 32.5 

By weight. 

yEtheris Nitrosi (Sweet Spirit of Nitre) . ethyl nitrite 4. 

Ammoniae ammonia gas 10. 

Ammoniae Aromaticus . . water 20; ammonia water 9. 

ammonia carb. 3.4 

oils, lavender, nutmeg, each 0.1 ; lemon oil 1. 

Chloroformi . . . . . .... chloroform 6. 

Glycerylis Nitratis nitroglycerin 1. 

The dose of these Spirits is from 30 to 60 minims (2 to 4 Cc. ; 
about 75 to 150 "drops"), except the Ammonia Spirit, used only 
in the preparation of Liniments (externally), and that of Glyceryl 
Nitrate, of which the dose is 1 minim (0.06 Cc). 

Unofficial Spirits of the National Formulary. 
Spiritus — 

Acidi Formici (Spirit of Ants, Ph. Ger.). — A solution of 
3 per cent, of Formic Acid in Water and Alcohol. 

Ophthalmicus (Alcoholic Eye-wash). — A solution of 10 min- 
ims (0.6 Cc.) Oil of Lavender and 30 minims (2 Cc.) Oil 
of Rosemary, in Alcohol 1 fluidounce (30 Cc). 

Saponatus (Spirit of Soap). 

SiNAPis (Spirit of Mustard, Ph. Ger.). — A solution of 2 J per 
cent, of Volatile Oil of Mustard in Alcohol. 

SYRUPI— SYRUPS. 

Syrups arc nearly saturated Solutions of Sugar in Water, in 
which aromatic or medicinal substances are dissolved. 

Syrups should be kept in a cool place, in cork-stoppered bottles, 
in order to preserve them. 

The official Syrup, Syrupus, contains 85 grams of sugar in 



PHARMA CE UTICAL PRE PARA TIONS. 75 

100 Cc. : with a smaller proportion of Sugar the syrup may 
undergo fermentation (spoil). 

The official Syrups are made by different methods : by solution, 
or mixing the medicinal substances with the syrup ; by dissolving 
the Sugar in the medicinal solution ; by extraction from the drug ; 
and by chemical reaction and solution. 

They may be divided into (1) the aromatic or adjuvant syrups, 
and (2) the medicinal syrups, comprising (a) those made from 
extractive drugs, and (b) those made from chemicals, either by 
simple solution or by chemical reaction and solution. 

The Aromatic or Adjuvant Syrups are mostly used to improve 
the taste of salty, bitter, or otherwise unpleasant mixtures. 

The following are official : 

Cc. in 100 Cc, 
Syrupus — or percentage by vol. 

Acaciae acacia 10. 

Acidi Citrici tincture of fresh lemon peel 1 . 

acid, citric 1. 

Amygdalae spirit of bitter almond I. 

orange flower water 10. 

Aurantii . tincture of sweet orange peel 5 ; citric acid 0.5 

Aurantii Florum sugar 85. 

orange flower water to make 100. 

Tolutanus tincture of tolu 5. 

Zingiberis fluidextract of ginger 3. 

The Extractive Syrupus are often made by mixing the Fluid- 
extract of the respective drugs with Syrup. 

Tinctures and Fluidextracts of resinous drugs often precipitate 
when mixed with Syrups and aqueous solutions. In order to fur- 
nish clear mixtures it is therefore sometimes necessary to mix the 
extractive preparation with Water, clarify the mixture by filtration, 
and dissolve the sugar in the filtered liquid. 

The following; are official : „ , _ 

*» Gm. of Drug 

Syrupus — in 100 Cc. 

Ipecacuanhas .... acetic acid 1 ; fluidext. ipecac 7, 

Krameriae fluidext. rhatany 45 

Lactucarii tinct. lactucarium 10 

Picis Liquidae tar 5 

Pruni Virginianae wild cherry 15 

spirit of cinnamon 0.4, potass, carb. 1 

Rhei fluidext. rhubarb 10 



76 A TEXT-BOOK OF MATERIA MEDICA. 

Gm. of Drug 
Syrupus — in 100 Cc. 

Rhei Aromaticus tinct. rhubarb, arom. 15. 

Rosae fluidext rose 12.5 

Rubi fluidext. rubus 25. 

Sarsaparillae Comp fl. ext. sarsaparilla 20. 

fl. ext. glycyrrh., senna, each 1.5 

oils, sassafras, anise, gaultheria, each 0.0 1 

Scillae vinegar of squill 45. 

Scillae Comp fl. exts. squill, senega, each 8. 

(Coxe's Hive Syrup) . . antimony and potass, tart. 0.2 

Senegae . fl. ext. senega 20. 

Sennae oil coriander 0.5 ; senna 25. 

The Chemical Syrups are an elegant class of preparations in 
which the taste of the medicinal agents is greatly modified. They 
do not keep well unless put up in small bottles completely .filled, 
ready for dispensing. Except the Syrup of Iodide of Iron, which 
is best preserved in bottles exposed to light, they should be kept 
in a cool and dark place. 

The following are official : Percentage, 

Gm. or Cc. 
Syrupus — in ioo. 

Acidi Hydriodici .... acid, hydriodic, by weight 1. 
Calcii Lactophosphatis .... calcium carbonate 2.5 ; 

lactic acid 6 ; phosphoric acid 3.6 

Calcis lime 6.5 

Ferri Iodidi ferrous iodide, by weight 5. 

Grains Percent' 
in 1 fluid- age by 
dram {4 Cc). vol. 

Ferri, Quininae et Strychninae Phosphatum : 
glyccrite of the phosphates of iron, quinine, 

and strychnine 25. 

Hypophosphitum . . . calcium hypophosphite 3 4.5 

potassium and sodium hypophosphites, each 1 1.5 

tincture of fresh lemon peel 0.5 ; acid hypo- 

phos. dil 0.2 

Hypophosphitum Comp. . calcium hypophos- 
phite 3.5; potassium and sodium hypophos- 
phites, each 1.75 ; ferric and manganese 
hyp< phosphites, each 0.225 ; sodium citrate 
0.375; quinine 0.11; strychnine 0.0115; 
diluted hypophosphorous acid 1.5. 



PHARMACEUTICAL PREPARATIONS. 77 

Unofficial Syrups of the National Formulary. 

Unless otherwise stated, the dose is I to 2 fluidrachms or tea- 
spoonfuls (4-8 Cc). 

Syrupus — 

Actmje Compositus (Cimicifuga or Black Cohosh). — Contain- 
ing 2\ grains (0.15) each of Cimicifuga and Wild Cherry, 
1 \ grains (0.07) Glycyrrhiza and Senega, and f grain (0.04) 
Ipecac in each fluidrachm (4 Cc). 
Asari Compositus (Canada Snake Root).— Each fluidrachm 

(4 Cc.) represents 3J grains (0.2) of Asarum. 
Calcii Chlorhydrophosphatis (Chlorhydrophosphate of 
Lime). — Each fluidrachm (4 Cc.) contains 1 grain (0.06) of 
Calcium Phosphate. 
Calcii et Sodii Hypophosphitum (Hypophosphite of Lime 
and Soda). — Each fluidrachm (4 Cc.) contains 2 grains (0.13), 
each, of Hypophosphites of Calcium and Sodium. 
Calcii Hypophosphitis (Hypophosphite of Lime). — Each 
fluidrachm (4 Cc.) contains 2 grains (o. 1 3) of Calcium Hypo- 
phosphite. 
Calcii Iodidi (Iodide of Calcium). — Each fluidrachm (4 Cc.) 

contains about 5 grains (0.3) of Calcium Iodide. 
Calcii Lactophosphatis cum Ferro (Lactophosphate of 
Lime with Iron). — Each fluidrachm (4 Cc.) contains \ grain 
(0.03) of Lactate of Iron and about \ grain (0.015) °f 
Calcium Lactate (or about f grain (0.02) of so-called Lacto- 
phosphate of Calcium). 
Chondri Compositus (Irish Moss). — Containing 1 grain (0.06) 
each of Squill and Senega, -^ grain (0.004) each of Ipecac 
and Irish Moss, and if minims (0.1) Tincture Opium Camph. 
to each fluidrachm (4 Cc). 
Cinnamomi (Cinnamon, Ph. Ger.). — Chiefly used for flavoring. 
Codeine. — Containing J grain (0.03) Codeine Sulphate in 
each fluidrachm (4 Cc). The Syrup of the French Codex 
is about one-fourth this strength. 
CoFFEiE (Coffee). — Containing 15 grains (1.) of the choicest 
Coffee (Java and Mocha) in fluidrachm (4 Cc.) ; an elegant 
vehicle for Quinine and addition to nauseous mixtures. 
Eriodictyi Aromaticus (Yerba Santa; Syrupus Corrigens). 
— Chiefly intended as a vehicle for disguising the taste of 
Quinine and other bitter substances. 
Ferri Arsenatis. — Each fluidrachm (4 Cc.) contains about 
■jfa grain (0.00 1) of Arsenate of Iron (ferric). 



7$ A TEXT-BOOK OF MATERIA MEDICA. 

Syrupus — 

Ferri Bromidi (U. S. P., 1880). — Containing 10 per cent, of 
Ferrous Bromide. 

Ferri Citro-iodidi (Tasteless Syrup of Iodide of Iron). — 
Each fluidrachm (4 Cc.) contains an amount of Iron corre- 
sponding to about 3.6 grains (0.25) of Ferric Iodide. The 
official Syrupus Ferri Iodidi contains about 8 grains (0.5) 
of Ferrous Iodide (Protiodide of Iron) in each fluidrachm 

(4 Cc). 

Ferri et Mangani Iodidi (Iodide of Iron and Manganese). — 
Each fluidrachm (4 Cc.) contains 6 grains (0.4) of Iodide 
of Iron (ferrous) and 3 grains (0.2) of Iodide of Manganese. 

Ferri Hypophosphitis (Hypophosphite of Iron). — Each fluid- 
drachm (4 Cc.) contains 1 grain (0.06) of Hypophosphite of 
Iron (ferric). 

Ferri Lactophosphatis (Lactophosphate of Iron). — Each 
fluidrachm (4 Cc.) contains 1 grain (0.06) of Lactate of 
Iron, or about 1^ grains (0.1) of so-called Lactophosphate 
of Iron. 

Ferri Protochloridi (Ferrous Chloride). — Each fluidrachm 
(4 Cc.) contains about 1 grain (0.06) of Protochloride of 
Iron. 

Ferri Saccharati Solubilis (Soluble Saccharated Iron; 
Saccharated Oxide of Iron, Ph. Ger.). — Each 75 minims (5 
Cc.) represents approximately 1 grain (0.06) of Metallic 
Iron, or 3 grains (0.2) of Oxide of Iron. 

Glycyrrhiz^e (Liquorice). — Each fluidrachm (4 Cc.) repre- 
sents 30 grains (2.) of Glycyrrhiza. 

Hypophosphitum Compositus. — Each fluidrachm (4 Cc.) con- 
tains 2 grains (0.12) of Calcium Hypophosphite, 1 grain 
(0.06), each, of the Hypophosphites of Potassium and 
Sodium, \ grain (0.008), each, of the Hypophosphites of 
Iron and Manganese, y 1 ^ grain (0.004) of Quinine Hydro- 
chlorate, and 1] minims (0.01) of Tincture of Nux Vomica. 

Syrup should not be confounded with the official Syrupus Hypo- 

phosphitum (Syrup of the Hypopho phites: Calcium, Sodium, and Potassium). 
It b intended to replace a well-known proprietary article, for which it has been 

found by many physicians to be a satisfactory substitute. It is uniform in com- 
position and more Stable and elegant than the patent article. 

IPECACUANHA ET OpII (Syrup of Dover's Powder).— Each 
flllidnu hm (4 Cc.) represents 5 grains (0.3) of Dover's Pow- 
der, or jj grain (0.03), ea< h, of [pecac and Opium. 



PHARMACEUTICAL PREPARATIONS. 79 

Syrupus — 

Manns (Syrup of Manna, Ph. Ger.). 

Morphine Compositus. — A preparation sometimes dispensed 
as Jackson's Pectoral Syrup, but, as it differs in essential 
particulars, the N. F. recommends that this preparation be 
dispensed only when expressly designated under this title. 
Each fluidrachm (4 Cc.) contains \ grain (0.008) Ipecac, 
5 grains (0.3) Senega, 1 grain (0.06) Rhubarb, and ^ 
grain (0.002) Morphine, with Oil of Sassafras. 

Morphine Sulphatis (Syrup of Morphine). — Each fluid- 
drachm (4 Cc.) contains ^ grain (0.008) of Sulphate of 
Morphine. 

Papaveris (Poppy, Ph. Br. ; Diacodii, Ph. Ger.). — Similar to the 
preceding, but considerably weaker. 

Pectoralis (Jackson's Pectoral Syrup). — Each fluidrachm 
(4 Cc.) contains ^ grain (0.002), each, of Morphine and Oil 
of Sassafras. 

Phosphatum Compositus (Chemical Food). — Each fluidrachm 
(4 Cc.) contains about 2 grains (0.12) of Phosphate of 
Calcium, 1 grain (0.06), each, of the Phosphates of Iron 
and Ammonium, and smaller quantities of the Phosphates 
of Potassium and Sodium. 

Pini Strobi Compositus (White Pine Compound). — A com- 
bination of White Pine, Wild Cherry, Spikenard, San- 
guinaria, Chloroform, and Morphine, -^ grain (0.002) in a 
fluidrachm. 

Rhamni Cathartics (Buckthorn Berries ; Syrupus Spinae 
Cervinae, Ph. Ger.). 

Rubi Aromaticus (Blackberry, Aromatic). — A combination 
of Rubus, Cinnamon, Nutmeg, Cloves, and Allspice. 

Sanguinary (Bloodroot). — Each fluidrachm (4 Cc.) repre- 
sents 13 grains (0.8) of Sanguinaria. 

Senns Aromaticus (Senna, Aromatic). — Each fluidrachm 
(4 Cc.) represents j\ grains (0.5) of Senna, 3 grains (0.2) 
of Jalap, and 1 grain (0.06) of Rhubarb, with aromatics. 

Senns Compositus (Senna, Compound). — Each fluidrachm 
(4 Cc.) represents 8 grains (0.5) of Senna, 2 grains (0.12), 
each, of Rhubarb and Frangula. 

Sodii Hypophosphitis. — Each fluidrachm (4 Cc.) contains 
2 grains (0.12) of Sodium Hypophosphite. 

Stillingis Compositus. — Each fluidrachm (4 Cc.) represents 
15 minims (1 Cc.) of Compound Fluid Extract of Stillingia. 



80 A TEXT-BOOK OF MA TERIA MEDICA 

Syrupus — 

Oxvmel Scill^e (Oxymel of Squill, Ph. Br.). — A preparation 
of Honey containing about 5 grains (.32 Gm.) of Squill in 
each fluidrachm (4 Cc). 

ELIXIRIA— ELIXIRS. 
Elixirs are a class of elegant preparations similar to wines or 
cordials, composed of Water, Sugar, Alcohol, and Aromatics. 

The medicinal substances are usually in such proportion that an 
ordinary dose may be contained in one or two teaspoonfuls (4 to 8 
Cc.) of the elixir. The official Elixirs are : 
Elixir Adjuvans : 

fluidextract of glycyrrhiza 12; aromatic elixir 88. 
Elixir Aromaticum : 

compound spirit of orange 1.2 ; syrup 37.5 ; alcohol 25. 
Elixir Ferri, Quininae et Strychninae Phosphatum : 

soluble ferric phosphate 1.75; quinine 0.875 ; strychnine 
0.0275 ; phosphoric acid 0.2 [each fluidram contains 
1 grain (0.06 Gm.) of ferric phosphate, and \ grain 
(0.03 Gm.) quinine, and ■£% grain (0.001 Gm.) strychnine 
in the form of phosphate]. 

Elixirs of the National Formulary. 
The value of pleasant vehicles to mask or modify the taste of 
bitter and nauseous drugs is recognized by every prescriber. The 
following Elixirs of the National Formulary have been carefully 
selected, and embrace the most effective combinations of adjuvants 
and aromatics for disguising the different drugs for which they are 
recommended : 

Elixir— 

Anisi; a combination of Anethol, Fennel, and Bitter Almond. 
Curassao (Curacao Cordial) ; a combination of Curagao, Orris, 
and a little Citric Acid. 

Adjuvant Elixirs. — The following are intended as vehicles for 
Quinine and similar bitter substances, and as adjuvants for Tinctures 
and Fluid Extracts of bitter and resinous drugs, such as Cinchona, 
Cascara Sagrada, etc. They all contain Glycyrrhiza, which, in the 
form directed in the N. F. (Russian Licorice Root, peeled), is most 
effective in masking the bitter taste of Quinine, when it is directed to 
mply suspended in the mixture without the use of acid for 
effecting solution. Acids precipitate the glycyrrhizin and destroy 
it- power of masking the bitter taste: 



PHARMACEUTICAL PREPARATIONS. 8 1 

Elixir — 

Adjuvans; a combination of Orange, Wild Cherry, Glycyr- 

rhiza, Coriander, and Caraway. 

Except for the exhibition of Quinine this is the most effective of the adju- 
vant Elixirs. 

Eriodictyi Aromaticum (Arom. Elixir Yerba Santa ; Elixir 

Corrigens). — A solution of Yerba Santa in Comp. Elixir of 

Taraxacum, intended as a vehicle for Quinine and other 

bitter remedies. 

GlycyrrhiZjE (Elixir of Licorice) ; a solution of Licorice in 

Aromatic Elixir, the most effective vehicle for Quinine. 
Glycyrrhiz^e Aromaticum ; Elixir of Licorice, with the addi- 
tion of strong aromatics. 
Taraxaci Compositum ; an improved form of this well-known 
compound, useful as a mild adjuvant. 
Medicinal Elixirs. — These comprise the Elixirs mostly in use ; 
also, a number of preparations in which the prescriber will find 
satisfactory substitutes, designated by scientific titles and of 
definite strength and uniform composition, intended to replace 
various nostrums. 

Active Drug in 

I Fluidrachm. 4 Cc. 
Elixir — grains. Gm. 

Acidi Salicylici 5 0.3 

Ammonii Bromidi 5 0.3 

Ammonii Valerian atis 2 0.12 

The odor and taste of the salt being well 
covered by the addition of vanilla and a 
little chloroform. 
Ammonii Valerianatis et Quinine. — The 

above, with Quinine Hydrochlorate .... \ 0.015 
Apii Graveolentis (Celery Compound). — Con- 
taining Celery, Coca, Kola, and Viburnum, 

each 4 0.25 

Bismuthi. — Bismuth and Ammonium Citrate . 2 0.12 

Buchu *j\ 0.5 

Buchu Compositum. — Buchu, Cubeb, Juniper, 

and Uva Ursi, combined 15 I. 

Buchu et Potassii Acetatis. — Elixir Buchu, 

with Potassium Acetate 5 0.3 

Caffeine. — Caffeine (in solution in Hydro- 

bromic Acid) I 0.06 

Calcii Bromidi c q,-i 

6 ' * 



82 A TEXT-BOOK OF MATERIA MEDICA. 

Active Drug in 

i Fluidrachm. 4. Cc. 
Elixir — Grains. Gm. 

Calcii Hypophosphitis 2 O.I2 

Calcii Lactophosphatis. — Calcium Lactate (in 

Phosphoric Acid) 1 0.06 

Catharticum Compositum. — Each fluidrachm 
(4 Cc.) contains Senna 7^ grains (0.5); Podo- 
phyllum 4 grains (0.25); Leptandra and 
Jalap, each 3 grains (0.2) ; Rochelle Salts 
y\ grains (0.5) ; and Sodium Bicarbonate 1 
grain (0.06). The mixture should be shaken. 

Chloroformi Compositum. — A mixture of 
equal parts of Chloroform, Tincture of 
Opium, Spirit of Camphor, Aromatic Spirit 
of Ammonia, and Alcohol, flavored with Cin- 
namon. The old title, " Chloroform Pare- 
goric," is recommended to be abandoned for 
the above. Each fluidrachm (4 Cc.) contains 
1 grain (0.06) of Opium and 1 1 minims (0.7) 
of Chloroform. 

Cinchona (Elixir Calisaya). — This preparation 
is from the best Calisaya Bark, representing 
about 2 grains (0.12) in each fluidrachm (4 
Cc). It is preferable to preparations made 
from Quinine and the cheaper alkaloids in 
being a more agreeable and effective anti- 
periodic tonic. 

Cinchona et Ferri (Calisaya and Iron; Fer- 

rated Elixir of Calisaya). — Phosphate of Iron . 2 0.12 

Cinchona et Hypophosphitum. — Calcium and 

Sodium Hypophosphites, each I 0.06 

Cinchona, Ferri, Bismuthi et Strychnine. 

— Phosphate of Iron 2 0.12 

Bismuth and Ammonium Citrate I 0.06 

Strychnine Sulphate yj^ 0.OOO7 

Cinchona, Ferri et Bismuthi. — Phosphate of 

Iron 2 0.12 

Bismuth and Ammonium Citrate 1 0.06 

Cinchona, Ferri et Calcii Lactophosphatis. 

— Phosphate- of Iron ij O.I 

Calcium Lactophosphate about 1 0.06 



PHARMACEUTICAL PREPARATIONS. 83 

Active Drug in 

1 Fluidrachm. 4 Cc. 
Elixir— Grains. Gm. 

Cinchona, Ferri et Pepsini. — Phosphate of 

Iron 1^ 0.1 

Pepsin I 0.06 

Cinchone, Ferri et Strychnine. — Phosphate 

of Iron 2 0.12 

Sulphate of Strychnine j^-^ 0.0007 

Cinchona, Pepsini et Strychnine. — Contain- 
ing smaller quantities of the Cinchona Alka- 
loids, Pepsin 1 grain (0.06), and Sulphate 

of Strychnine -^-^ 0.0007 

Coce (Coca). — Leaves; Erythroxylon Coca . . 7i °-5 
Coce et Guarane. — Coca and Guarana, of each 7 J 0.5 
Corydalis Compositum. — Containing of Cory- 
dalis, Stillingia, Iris, and Xanthoxylum, 

combined 15 1. 

Potassium Iodide 3 0.2 

Digestivum Compositum. — Containing about 5 
grains (0.3) of Pulvis Digestivus in each 
fluidrachm (4 Cc). 

Eucalypti. — Eucalyptus Globulus 7} 0.5 

Euonymi (Wahoo). — Euonymus Atropurpureus 10 0.6 
Ferri Hypophosphitis. — Hypophosphite of 

Iron (ferric) 1 00.6 

Ferri Lactatis 1 0.06 

Ferri Phosphatis. — Phosphate of Iron (U. S. P.) 2 o. 1 2 
Ferri Phosphatis, Cinchonidine et Strych- 
nine. — Phosphate of Iron 2 0.12 

Cinchonidine -^ 0.03 

Sulphate of Strychnine YTU" 0-0007 

Ferri Phosphatis, Quinine et Strychnine. 
— Phosphate of Iron, I grain (0.06) ; Qui- 
nine -|- 0.03 

Sulphate of Strychnine -fa 0.001 

Ferri Pyrophosphatis 2 0.12 

Ferri, Quinine et Strychnine. — Ferric Chlo- 
ride, 1 grain (0.06) ; Quinine Hydrochlorate -|- 0.03 

Sulphate of Strychnine jfo 0.0007 

Frangule (Buckthorn). — Rhamnus Frangula . 15 I. 



84 A TEXT-BOOK OF MATERIA MEDICA. 

Active Drug in 

i Fluidrachm. 4 Cc. 
Elixir — Grains. Gm. 

Gentian.e. 2 0.12 

Gentians cum Tixctura Ferri Chloridi. — 

Tincture Citro-chloride of Iron 5 0.3 

Gentian.e et Ferri Phosphatis (ferrophos- 

phated). — Phosphate of Iron 1 0.06 

Grindeli^. — Grindelia Robusta 4 0.25 

GuaraNjB. — Paullinia Cupana 12 0.75 

Humuli j\ 0.5 

Hypophosphitum. — Calcium Hypophosphite . 3 0.2 

Sodium and Potassium Hypophosphites, each 1 0.06 
Hvpophosphitum cum Ferro. — Calcium and 

Sodium Hypophosphite, each 1 0.06 

Potassium and Iron Hypophosphites, each . J 0.03 

Lithii Bromidi 5 0.3 

Ltthii Citratis 5 0.3 

Lithii Salicylates 5 0.3 

Malti et Ferri. — Phosphate of Iron .... 1 0.06 

Malt Extract 15 1. 

Paraldehydi. — Paraldehyde 15 1. 

Pefsini. — Pepsin • . . . 1 0.06 

Pefsini, Bismuthi et Strychnine. — Elixir Peo- 

sin and Bismuth, and Strychnine .... yj* 0.0007 

Pepsin 1 et Bismuthi. — Pepsin 1 0.06 

Bismuth and Ammonium Citrate 2 0.12 

Pepsin 1 et Ferri. — Elixir of Pepsin and Tinc- 
ture Citro-chloride of Iron 5. 0.3 

PHOSPHOR! et Nucis Vomic/e. — Elixir Phos- 
phorus, with Tincture Nux Vomica ... 2 0.12 
PlCIS COMPOSITUM. — A combination of Prunus 
Virginiana,Tolu, Methylic Alcohol, and Sul- 
phate of Morphine ^ 0.0015 

Pilocarpi (Jaborandi). — Pilocarpus Selloanus . 4 0.25 

POTASSIl ACETATIS 5 0.3 

POTASSU ACETATIS ET JUNIPERI. — Elixir Potass. 

Acet with Juniper 7j 0.5 

Potass 11 Bromidi. — Potassium Bromide, effect- 
ually masked in Adjuvant Elixir .... 10 0.6 
An Elixir half this strength has also been used. 



PHARMACEUTICAL PREPARATIONS. 85 

Active Drug in 

1 Fluidrackm. 4 Cc. 
Elixir — Grains. Gm. 

Quinine Compositum (Red). — Sulphates of 
Quinine, \ grain (0.008), Cinchonidine and 

Cinchonine, each ^ 0.OO4 

Chiefly intended as a substitue for Elixir 
Cinchona when the administration of other 
constituents of the bark may be deemed ob- 
jectionable. 

Quinine et Phosphatum Compositum. — Qui- 
nine Sulphate J 0.015 

Phosphate of Iron 1 0.06 

Calcium Lactophosphate f 0.05 

Quinine Valerianate et Strychnine. — Va- 
lerianate of Quinine 1 0.06 

Sulphate of Strychnine y-l-g- 0.0007 

Rhamni Purshiane (Cascara Sagrada). — Rham- 
nus Purshiana, its bitterness effectually masked 
with Elixirs of Glycyrrhiza and Taraxacum 
Compound 15 1. 

Rhamni Purshiana Compositum (Laxative 

Elixir; Elixir Purgans). — Cascara Sagrada . j\ 0.5 

Senna and Juglans, each 5 0.3 

Associated with aromatics and correctives ; 
a most effective laxative in doses of from 1 to 2 
fluidrachms (4-8 Cc). 

Rhei. — Sweet Tincture of Rhubarb, represent- 
ing Rhubarb 2 \ 0.15 

Rhei et Magnesia Acetatis. — Magnesium 

Acetate, 4 grains (0.25) ; Rhubarb 7i °-S 

Rubi Compositum (Blackberry Compound). — 
Blackberry Root, Galls, and Cinnamon (Sai- 
gon), in equal proportions, combined .... 10 0.6 
with smaller quantities of Cloves, Mace, and 
Ginger, in Blackberry Juice and Syrup. 

Sodii Bromidi. — Sodium Bromide, in Adjuvant 

Elixir 10 0.6 

Sodii Hypophosphitum 2 0.12 

Sodii Salicylatis (to be freshly prepared when 

required for use) 5 0.3 



86 A TEXT-BOOK OF MA TERIA MEDICA. 

Active Drug in 

I Fluidrachm. 4. Cc. 
Elixir — Grains. Gm. 

Stillingi^e Compositum. — Compound Fluid 

Extract of Stillingia, N. F 15 1. 

Strychnine Valerianate yJ-^ 0.0007 

Turners (Damiana). — Turnera Aphrodisiaca . 10 0.6 
Viburni Opuli Compositum. — Viburnum Opu- 

lus, Aletris Farinosa, each 5 0.3 

Trillium (Beth Root) 10 0.6 

Viburni Prunifolii (Black Haw) 7} o.J 

Zinci Valerianate. — Zinc Valerianate ... 1 0.06 



Cordiale Rubi Fructus (Blackberry Cordial). — An aromatic 
Syrup of Blackberry Juice, used as a mild astringent in bowel 
complaints. 

Succus Limonis cum Pepsino (Lime Juice and Pepsin). — Each 
fluidrachm (4 Cc.) represents 2 grains (0.12) of Pepsin. 

GLYCERITA— GLYCERITES. 

The Glycerites, or " Glyceroles," are solutions of substances in 
Glycerin. 

They are made either by direct solution, by heat, or by extrac- 
tion of a drug, as in Hydrastis ; one is made by chemical reaction 
— i. e. Boroglycerin. 

Glyccritum— Percentage by weight. 

Acidi Tannici acid, tannic 20. 

Amyli water 10 ; starch 10. 

Boroglycerini . . . . (boric acid 31. or) boroglyceride 50. 

Glyccritum Ferri, Quininae et Strychninae Phosphatum 

soluble ferric phosphate 8, quinine 10.4, strychnine 0.08, 

phosphoric acid 20 [1 Cc. contains 0.104 Gm. (if 

gr.) quinine, and 0.0008 Gm. (^ gr.) strychnine]. 

Hydrastis representing hydrastis 100. 

Phenolis liquefied phenol 20. 

The Glycerite of Starch is used chiefly as an excipient for Pill- 

Unofficial Glycerites of the National Formulary. 

Glyccritum 

Pepsin] (Glycerole of Pepsin); — Each 4 Cc. (fluidrachm) repre- 

:ts °«3 (5 grains) of Pepsin. 
Picis Liquidje (Tar). — Containing about 0.3(5 grains) of Tar. 
mii i.. — Containing about 12 per cent, of tragacanth. 



PHARMACEUTICAL PREPARATIONS. 87 

MUCILAGINES— MUCILAGES. 

The Mucilages are prepared by extracting a mucilaginous drug 
with Water or dissolving a Gum in Water. 
The following four are official : 

Gm. in 100 Cc, 
Mucilago — or percentage. 

Acaciae lime water 33 ; acacia 34. 

Sassafras Medullas sassafras pith 2. 

Tragacanthae glycerin 1 8 ; tragacanth 6. 

Ulmi slippery-elm bark 6. 

The Mucilages are chiefly employed as vehicles in Mixtures to 
aid in suspending insoluble substances ; as excipients in Pills and 
Troches; and as emulsifying agents. They are sometimes used 
for their demulcent effect. 



THE LIQUID MIXTURES— INTERNAL. 

MISTUR.E— MIXTURES. 

The official Mixtures are liquid preparations, for internal use, 
of medicinal substances suspended in Water containing sugar y gum, 
or glycerin. They require to be shaken up before using. They 
should be prepared extemporaneously. The term Mixture is also 
applied to any combination of substances that cannot be otherwise 
classified. 

There are four official mixtures : 

Mistura — Gms. in 100 Cc. 

Cretae (Chalk Mixture) .... comp. chalk powder 20. 

cinnamon water 40; water, to 100. 

Ferri Comp. (Griffith's Mixt.) . . . myrrh, sugar, each 1.8 

potass, carb. 0.8 

triturate with gradual addition of rose water 70. 

ferrous sulphate, 0.6 ; spir. lavend., 6 ; rose water, to 100. 

Glycyrrhizae Comp. .... pure extract glycyrrhiza 3.0 

(Brown Mixture) Spirit nitrous ether 3. 

wine antimony 6. 

tinct. opium, camph. 12. 

syrup 5 ; acacia 3 ; water, to 100. 

Rhei et Sodae sodium bicarbonate 3.5 

fl. exts. ipecac 0.3, rhubarb 1.5 

spirit peppermint 3.5 ; glycerin 35.; water, to 100. 



88 A TEXT-BOOK OF MATERIA MEDICA. 

Unofficial Mixtures of the National Formulary. 

Mistura— 

Acacle — (Mistura Gummosa, Ph. Ger.). — Acacia, pulv., Sugar, 
in Water. 

Should be freshly made when wanted for use. 

Adstringens et Escharotica (Villate's Solution). — Solu- 
tion of Lead Subacet. i-^- fluidounces (45.); Sulphates of 
Copper, Zinc, each, 1 troy ounce (30.) ; Acetic Acid 13 fluid- 
ounces (360 Cc). 

Ammonii CHLORiDr (Mistura Solvens Simplex). — Ammonium 
Chloride, Purif. Ext. Glycyrrhiza, each 180 grains (12.), in 
Water 16 fluidounces (450 Cc). 

Mistura (or Mixtura) Solvens Stibiata is prepared by dis- 
solving 0.3 Antimony and Potassium Tartrate in iooo Cc. 
of Mistura Ammonii Chloridi. 

Camphor/E Acida (Mistura Antidysenterica ; Hope's Mix- 
ture). — Nitric Acid 120 mins. (8 Cc.) ; Tinct. Opium 80 
mins. (5 Cc.) ; in Camphor Water 16 fluidounces (450 Cc). 

Camphors Aromatica (Parrish's Camphor Mixture). — Tinct. 
Lavender Comp. 4 fluidounces (120 Cc.) ; Sugar 240 grains 
(15.); in Camphor Water 16 fluidounces (450 Cc). 

Carminativa (Dalby's Carminative). — Magnes. Carb. I troy 
ounce (30.); Potass. Carb. 20 grains (1.3); Tinct. Opium 
180 mins. (12 Cc) ; Oils of Caraway, Fennel, Peppermint, 
each, 4 drops (0.1); Syrup 2\ fluidounces (75 Cc.) ; in 16 
fluidounces (450 Cc). Each fluidounce (30 Cc.) represents 
about 1 grain of Opium (c.06). 

Chloralis et Potassii Bromidi Composita (Mixture of 
Chloral and Bromide). — Each fluidrachm (4 Cc.) contains 
15 grains (1.), each, of Chloral and Potassium Bromide, 
and J grain (0.008), each, of Exts. Indian Cannabis and 
Hyoscyamus. 

Chloroform] et Cannabis Indic/e Composita {Chloroform 

Anodyne). — Each fluidrachm (4 Cc.) represents j\ minims 

(0.5 Cc), each, of Chloroform and Tinct. Indian Cannabis; 

minims (0.25 Cc.) Tinct. Capsicum; and about \ grain 

(O.OI ) of Morphine Sulph. 

Com k\ DlARRHCEAM {Cholera Mixture). — Tinctures of Opium, 
mi, Rhubarb, and Spirits of Camphor and Pepper- 
mint, ea< li, equal volumes. 

rhe above formula appears to be that in most general 
11 1 ■. al known under the name of "Sun Mixture." 



THE LIQUID MIXTURES-INTERNAL. 89 

Mistura — 

Of other similar preparations in more or less general use, 
the following may be mentioned here : 

2. Loomis' Diarrhea Mixture. — Tincture Opium, \ fluid- 
ounce (15 Cc) ; Tincture Rhubarb, \ fluidounce (15 Cc.) ; 
Tincture Catechu Comp., 1 fluidounce (30 Cc.) ; Oil of Sas- 
safras, 20 minims (1.3 Cc.) ; Tincture Lavender Comp., to 
make 4 fluidounces (120 Cc). 

3. Squibb's Dian'Jiea Mixture. — Tincture Opium, 1 fluid- 
ounce (30 Cc.) ; Tincture Capsicum, 1 fluidounce (30 Cc.) ; 
Spirit of Camphor, 1 fluidounce (30 Cc.) ; Purif. Chloroform, 
180 minims (12 Cc.) ; Alcohol, enough to make 5 fluidounces 
(150 Cc). 

4. Thielemann's Mixture (Mixt. Thielemanni, Ph. Suec). — 
Wine Opium, 1 fluidounce (30 Cc.) ; Tinct. Valerian, \\ 
fluidounces (45 Cc.) ; Ether, \ fluidounce (15 Cc.) ; Oil 
Peppermint, 60 minims (4 Cc) ; Fl. Ex. Ipecac, 1 5 minims 
(1 Cc); Alcohol, to make 4 fluidounces (120 Cc). 

5. Velpeau's Diarrhea Mixture. — Tincture Opium, Tinc- 
ture Catechu Comp., Spirit Camphor, of each, equal volumes. 

Copaiba Composita — 

1 . Lafayette Mixture. — Copaiba, 2 fluidounces (60 Cc) ; 
Tinct. Lavender Comp., 2 fluidounces (60 Cc.) ; Solution 
Potassa, \ fluidounce (15 Cc) ; Spirit Nitr. Ether, 2 fluid- 
ounces (60 Cc.) ; Syrup, 5 fluidounces (150 Cc.) ; Mucilage 
Dextrin, to make 16 fluidounces (450 Cc). This mixture 
should be well agitated when used. Each fluidrachm con- 
tains y\ minims of Copaiba. 

2. Chapman's Mixture. — Copaiba, 4 fluidounces (125 Cc) ; 
Tinct Lav. Comp., 240 minims (15.5 Cc) ; Tincture Opium, 
240 minims (15.5 Cc.) ; Spirit Nitro. Ether, 4 fluidounces 
(125 Cc) ; Mucilage Acacia, 1 \ fluidounces (45 Cc.) ; Water, 
to make 16 fluidounces (450 Cc). 

Expectorans, Stokes (Stokes' Expectorant). — Ammonium 
Carb., 120 grains (8.); Fl. Ext. Senega, \ fluidounce (15 
Cc); Fl. Ext. Squill, \ fluidounce (15 Cc.) ; Tinct. Opium, 
Camph., 2 J fluidounces (80 Cc.) ; Water, \\ fluidounces (45 
Cc); Syrup Tolu, to make 16 fluidounces (450 Cc). 

Guaiaci (Guaiac Mixture, Ph. Br.). — Resin Guaiac, Sugar, each, 
190 grains (12.5); Acacia Powder, 100 grains (7.); Cinna- 
mon Water, 16 fluidounces (450 Cc). To be well agitated 
when used. 



90 A TEXT-BOOK OF MA TERIA MEDICA. 

Mistura— 

Magnesia et Asafcetim: (U. S. P. 1880). — Dewees' Carmina- 
tive. — Magnesium Carbonate, 90 grains (6.0); Tinct. Asa- 
foetida, 2 fluidrachms (8 Cc.) ; Tinct. Opium, 20 minims (1.2 
Cc); Sugar, 180 grains (12.0); Water, to make 4 fluid- 
ounces (120 Cc). 

Olei Balsamica (Balsamum Vitae HofTmanni, Ph. Ger.). — 
A solution of Oils of Lavender, Thyme, Lemon, Mace, 
Orange-flowers, Cloves, Cinnamon, and Balsam Peru in 
Alcohol. 

Olei Picis (Tar Mixture). — A mixture of Oil of Tar, \ fluid- 
ounce (15 Cc.) ; Chloroform, 75 minims (5 Cc.) ; Oil of Pep- 
permint, 20 minims (1.3 Cc), in Elixir, to make 16 fluid- 
ounces (450 Cc). 

Rhei Composita (Squibb's Rhubarb Mixture). — Fl. Ext. 
Rhubarb, 120 minims (6. Cc.) ; Fl. Ext. Ipecac, 16 minims 
(1. Cc.) ; Sodium Bicarb., 330 grains (11.); Glycerin, 6 fluid- 
ounces (240.), in Peppermint Water, 16 fluidounces (450 Cc). 

Sassafras et Opii (Mist. Opii Alkalina ; Godfrey's Cordial). — 
A mixture of Oil of Sassafras, Tincture of Opium, and Potass. 
Carb. in Molasses, Alcohol, and Water. Each fluidrachm 
(4 Cc.) contains 2 minims (0.12) Tinct. Opium, correspond- 
ing to \ grain (0.0 1) Opium. 

Sod^e et Mentha (Soda Mint). — Sodium Bicarb., 320 grains 
(20.) ; Spirit Ammonia Arom., 4 Cc (60 minims) ; Spear- 
mint Water, 16 fluidounces (450 Cc). 

Splenetica (Spleen Mixture ; Gadberry's Mixture). — Iron 
Sulphate, Quinine Sulphate, Nitric Acid, each, 100 grains 
(7.); Potassium Nitrate, 300 grains (20.), in Water, 16 fluid- 
ounces (450 Cc). 

Sulphurica Acida (Haller's Acid Elixir, Ph. Ger.). — Sul- 
phuric Acid, 1 part ; Alcohol, to make 4 parts, by weight. 

KM ULSA— EMULSIONS. 
Emulsions are liquid preparations consisting of oily, fatty, re sin- 
ous, or otherwise insoluble substances suspended in watery liquids 
by the intervention of gum, mucilage, or other viscid matter. The 
object of emulsifying a substance is to render it easily miscible with 
water. 

■v the internal administration of Oils it is often necessary to 
exhibit them in a palatable form, so that they may be borne by the 
Stomach and their assimilation favored. This is usually effected by 



THE LIQUID MIXTURES— INTERNAL. 91 

suspending the oil in a watery liquid or mixture by means of an 
emulsifying agent, such as acacia, etc. 

Many natural substances are intimate mixtures of oils or fats 
with water, in the form of an emulsion. Of animal products, Milk 
is a most perfect emulsion; so is Egg-yolk. From the Milk-juice 
of some plants the water evaporates and the dried milk-juice col- 
lects in portions of the plant or exudes from them when wounded ; 
in this way the gum-resins of asafcetida, etc., are produced. From 
these substances Emulsions may be obtained by restoring the water 
lost by evaporation — that is, by rubbing them with water in a mortar. 
In this way the so-called natural Emulsions are made. 

Artificial E7?iulsions. 

These are made by mixing the Oil with a certain proportion of 
the emulsifying agent, adding Water, and triturating the mixture in 
a mortar or agitating it in a flask. 

There are various methods, but these are general rules : 

The emulsification of the oil should be complete before the mixture is made up to the 
required measure. 

When alcoholic liquids are to be added, they should first be diluted as much as 
possible. 

Salts should be dissolved before being added. 

No heat should be employed, as the oil separates when an emulsion is heated. 

Emulsions should be freshly prepared and be preserved in a cold place. 

The most common emulsifying agent is Powdered Gum Acacia 
(Acacia pulv.). The Oil is thoroughly mixed by trituration in a 
mortar with one-fourth its weight of powdered Acacia. To this 
one and a half times as much water as of gum is added at once, and 
the mixture is rapidly triturated with a rotary motion of the pestle 
until it becomes stiff and assumes a milk-white color. This so- 
called " mother-emulsion " may now be diluted to the required 
measure, and other substances, flavors, etc. be added. 

Powdered Tragacanth may be used in the same way or in the 
form of mucilage, but it does not produce so permanent emulsions 
as does gum acacia. 

The Mucilages of Acacia and of Irish Moss are not so satisfactory 
as powdered gum : while they produce a good emulsion, the division 
of the oil-globules is not so thorough as in the preceding : emulsifi- 
cation being incomplete, the mixture more rapidly separates into a 
heavier, watery liquid and a lighter, thick, gelatinous emulsion, 
which requires thorough mixing before use. 



92 A TEXT-BOOK OF MA TERIA MEDICA. 

Extract of malt is an excellent emulsifying agent when its use is admissible. The 
Oil should be added to the Malt Extract contained in a capacious mortar, and incorporated 
in small quantities at a time. A good article will emulsify an equal volume of cod- 
liver oil. 

Condensed Milk and Egg-yolk produce the most perfect emulsions, and also the 
most palatable, but they rapidly ferment and spoil. 

Glycerin and sugar added to emulsions for the purpose of preservation and paya- 
bility induce separation, and their use is not advisable. 

Emulsification " by intervention " is the best and only reliable 
method to be employed with Ethereal Oils and all substances of 
themselves not emulsifiable. The process is illustrated in the 
official Chloroform Emulsion. 

Oil of Turpentine, for example, is emulsified by dissolving the Turpentine Oil in 
a bland fixed oil (Almond Oil), incorporating an equal weight of powdered Acacia, 
adding Water, and proceeding as with an ordinary emulsion. 

Pancreatin emulsionizes fats in preparing them for digestion, but it does not produce 
a permanent emulsion when used artificially. While, therefore, not a reliable emulsifying 
agent, it aids the assimilation of oils, and its addition to emulsions is sometimes therapeu- 
tically desirable. As it is more active in alkaline media, the Emulsion should be pre- 
pared with a little Sodium Bicarbonate. 

The addition of Alkalies to emulsions should be avoided. Soaps are not Emulsions, 
nor is the use of Soap-bark to be recommended. 

The official emulsions are : 

Gm. in ioo Cc, 
Emulsum — or percentage by vol. 

Amygdalae sweet almond 6. 

sugar 3 ; acacia I. 

Asafoetidae asafcetida, in select tears 4. 

Chloroformi .... tragacanth powd. 1 ; chloroform 4. 

expressed oil of almond 6. 

Olci Morrhuae cod liver oil 50; oilofgaul- 

theria 0.4; acacia 12.5; syrup 10. 

Olci Morrhuae cum I lypophosphittbus cod 

liver oil 50; oil of gaultheria 0.4; syrup 10; cal- 
cium hypophosphitc 1 ; potassium and sodium 

hypophosphites 0.5 

Olci Terebinthinae rectified oil of turpentine 15. 

expressed oil of almond 5; syrup 25; acacia 15. 

Unofficial Emulsions of the National Formulary. 

Emulsions should, of all pharmaceuticals, be prepared within a 

onable period previous to the time of dispensing. A true 

emulsion should contain the oil simply suspended in the form of a 

lanical mixture, which, from' its very character, cannot with- 

<»f variation in temperature any better than a 



THE LIQUID MIXTURES— INTERNAL. 93 

natural emulsion, such as milk or emulsions of almonds, gum- 
resins, etc., and consequently quickly degenerates or spoils. 

An emulsion may be perfect — that is, the oil-globules entirely 
extinguished — yet a separation similar to that occurring in milk 
will take place, which, though in its first stage not so objection- 
able, will eventually impair the medicinal value of the preparation. 
These reasons are, it is believed, sufficient to condemn the various 
"ready-made" or patent emulsions, and to justify the physician in 
prescribing such as are kept on hand by the pharmacist, in smaller 
quantities, prepared according to these formulas. 

A typical formula for emulsions, with Acacia, is — 

^. Olei Morrhuse 120 Cc, giv; 

Acaciae pulv 30 Gm., 3j ; 

Aquae q. s. ad 240 Cc, Iviij. 

Emulsify by trituration in a mortar, and add the flavoring. 

The following are flavors employed: (1) Gaultheria, (2) gaul- 
theria and sassafras, (3) aromatic spirit, (4) gaultheria, bitter almond, 
and coriander, (5) gaultheria, sassafras, and bitter almond, (6) gaul- 
theria and bitter almond, (7) oil of neroli, bitter almond, and cloves. 
Unless otherwise specified, that designated as No. 5 may be em- 
ployed in these Emulsions. 

The following formulas may be useful as indicating the form of 
prescription for any combination desired. Hypophosphite Salts or 
any medication desired may usually be dissolved in the water 
directed in the formula, should a preparation be indicated different 
from any of the following emulsions of the N. F. : 
Emulsio — 

Olei Morrhile cum Calcii et Sodii Phosphatibus. — Cal- 
cium Phosphate, Sodium Phosphate, of each, 1 grain in 1 
fluidrachm (0.06 in 4 Cc). 

Olei Morrhile cum Calcii Lactophosphate. — Calcium 
Lactophosphate, 3 grains in 1 fluidrachm (0.2 in 4 Cc). 

Olei Morrhu^e cum Calcii Phosphate. — Calcium Phos- 
phate, 2 grains in 1 fluidrachm (0.12 in 4 Cc). 

Olei Morrhuse cum Extracto Malti. — Contains 40 per 
cent. Extract of Malt. 

Olei Morrhu^e cum Hypophosphite. — The Hypophosphite 
Salt or any combination of the following: Calcium, Po- 
tassium, Sodium, or Iron, to be directed by the prescriber, 
8 grains to the fluidounce (0.5 in 30 Cc). 



94 A TEXT-BOOK OF MATERIA MEDIC A. 

Emulsio — 

Olei Morrhile cum Pruno Virginiana. — Wild Cherry 

(Fluid Ext.), \ fluidrachm to I fluidounce (2 Cc. in 30 Cc). 
Olei Ricini. — 1 fluidounce (30 Cc.) contains 2\ fluidrachms 

(10 Cc.) Castor Oil, disguised by the addition of Vanilla. 
Olei Terebinthin^:. — Contains 1 fluidrachm (4 Cc.) Oil of 

Turpentine 1 fluidounce (in 30 Cc), prepared according to 

the following formula: 

fy. Olei Terebinthinae 3iv, 12.5 Cc; 

Acacise pulv gr. xxx, 2.0 

Vitelli Ovi (Egg-yolk) ; 

Elixir Aromatici .... ana 3iv, 15 Cc; 
Aquae Cinnamomi . . q. s. ad ^iv, IOO Cc. 
Make an emulsion by trituration in a mortar. 

Phosphatica (Phosphatic Emulsion). — Prepared with Glycerite 
of Egg-yolk, and contains in 1 fluidounce (30 Cc) Cod 
Liver Oil, 2 fluidrachms (8 Cc.) ; Dilute Phosphoric Acid, 
22-J minims (1.5 Cc.) ; Jamaica Rum, flavored with Bitter 
Almond and Orange Flower Water. 



EXTRACTIVE PREPARATIONS. 

The active medicinal constituents, or principles, of crude drugs 
are obtained by extraction. Extraction is effected either by macera- 
tion, expression, and filtration or straining, or by maceration with 
heat, when it is called digestion, or by percolation. The liquid 
employed, termed menstruum (pi. menstrua), may be Water or Al- 
cohol, or Alcohol and Water in various proportions, sometimes 
with Glycerin. A few drugs require alkaline menstrua, some 
acid menstrua, while the oleoresins are made with Acetone (except 
Cubeb, which is made with Alcohol). 

The Infusions and Decoctions are the simplest preparations made 
by extraction, and represent most nearly all the soluble constitu- 
ents of the drugs. But not all drugs arc adapted to this method 
of extraction nor to this exceedingly effective, though not espe- 
cially elegant, form of exhibition. Also infusions and decoctions 
Spoil easily unless alcohol is added as a preservative. 

rhc most generally convenient and effective class of extractive 

nations arc the Tinctures. They are the simplest form of alco- 

holic preparations, and the other more concentrated 'pr^para^ens are 



EX TRA CTI VE PRE PARA TIONS. 95 

usually first obtained as tinctures and then concentrated by evapora- 
tion, so as to yield the fluidextract, extract, or resin respectively. 

INFUSA— INFUSIONS. 

Unless otherwise directed, Infusions are prepared by the general 
official process : 

The substance, coarsely comminuted 5 Gm. 

Boiling Water ioo Cc. 

Pour the boiling Water on the Drug, in a suitable vessel provided with a cover, and 
let it stand for half an hour ; strain with expression and add enough Water through the 
strainer to make ioo Cc. 

Caution. — The strength of Infusions of energetic or powerful 
substances should be especially prescribed. The following Infusions 
are official, being prepared of different strengths and by other 
processes than directed in the general formula. 

Gm. in ioo Cc. 

Infusum Digitalis . alcohol 10; cinnamon water 15 ; digitalis 1.5 
Infusum Sennae Comp. (Black Draught) . . fennel 2 ; senna 6. 

manna, magnesium sulph., of each 12. 

To allow the emulsin and amygdalin of wild cherry to react, 
with the production of hydrocyanic acid and oil of bitter almonds, 
the drug must first be macerated with cold water, and is then extracted 
by percolation. 

Gm. in 100 Cc. 

Infusum Pruni Virginianae wild cherry 4. 

Unofficial Infusions of the National Formulary. 
Infusum — 

Bravery (U. S. P. 1880).— Bray era (Cusso), 6 ; Boiling Water, 

100 Cc. To be dispensed without straining the mixture. 
Gentians Compositum Fortius. — For preparing Infusum 

Gentianae Compositum by mixing 1 volume with 3 volumes 

of water. 
Ros,e Compositum (Compound Infusion of Rose, Ph. Br.). — 

An infusion of Red Rose in diluted Sulphuric Acid, Sugar, 

and Water. 

The Species (Teas) are mixtures of drugs contused or bruised 
for the preparation of Cataplasms ; or Infusions and Decoctions, 
sometimes designated as Haustus (Draught). The following are 
in the National Formulary: 



g6 A TEXT-BOOK OF MA TERIA MEDICA. 

Species — 

Emollientes (Emollient Cataplasm, Ph. Ger.). — A mixture of 
Althaea Leaves, Mallow Leaves, Melilot Tops, Matricaria, 
and Flaxseed, equal parts of each. 

Laxantes (St. Germain Tea, Ph. Ger.). — A mixture of Senna, 
Elder-flowers, Fennel, Anise, and Potassium Bitartrate. 

Pectorales (Breast Tea, Ph. Ger.). — A mixture of Althaea, 
Coltsfoot, Glycyrrhiza, Anise, Mullein Flowers, and Orris 
Root. 

Infusum Perforate (Pectoral Infusion, or Infusion of Pec- 
toral Species) is made by infusing I troy ounce (30 Gm.) 
of the above in the usual manner, so as to obtain 10 fluid- 
ounces (300 Cc.) of strained product. 

DECOCTA— DECOCTIONS. 

Unless otherwise directed, Decoctions are prepared according 
to the following general process : 

The substance, coarsely comminuted 5 Gm. 

Water, to make 100 Cc. 

Pour the Water on the Drug, contained in a suitable vessel provided with a cover, 
bring it to a boil, and let it boil for fifteen minutes ; let it cool to 40 C. (104 F.), 
express, strain, and add cold Water through the strainer to make IOO Cc. 

Caution as with Infusions. 

There are no official decoctions. 

Decoctum Aloes Compositum, N. F., is a mixture of Ext. Aloes, 
Myrrh, Saffron, Potass. Carb., Ext. Glycyrrh., Tinct. Cardamom 
Comp., and Water. — Extempore. 

ACETA— VINEGARS. 
The Vinegars are made by extraction with Dilute Acetic Acid. 

By maceration : 
Acetum Gm. in 100 Cc. 

Opii (Black Drop) . sugar 20; nutmeg 3; powd. opium 10. 
Scillae squill 10. 

VINA— WINES. 

The Wines arc made by solution, by maceration, or by macera- 
tion and percolation. The Menstruum is White Wine (except in 
Wine of (oca) with or without the addition of Alcohol (added to 
aid in the extraction and the preservation). There are ten Wines 
0ffi< ial. 

The Natural Wines: Vinum Album and Vinum Rubrum are 
treated under . Xlcohol. 



EXTRACTIVE PREPARATIONS. 97 

Vinum — Gm. in ioo Cc. 

Antimonii antimony, potass, tart. 0.4 

Cocae (made with red wine) fluidextract 6.5 

Colchici Seminis colchicum seed 10. 

Ergotae ergot 20. 

Ferri iron and ammonium citrate 4. 

syrup 10; tinct. sweet orange peel 6. 

Ferri Amarum . . . soluble iron and quinine citrate 5. 

(Bitter Wine of Iron) tinct. sweet orange peel 6 ; syrup 30. 

Ipecacuanhas alcohol 10; fluidext. ipecac 10. 

Opii cinnamon, cloves, each, 1 ; opium 10. 

The Dose of the Vinegar and Wine of Opium is the same, 10 
minims (0.6) representing 1 grain (0.06) opii pulvis. The dose of 
the Wine of Colchicum Seed is 30 minims (2 Cc). 

Unofficial Wines of the National Formulary. 
The Wines, with a few exceptions, are prepared with White 
Wine ( Vinum album, U. S.), usually with the addition of 10 per 
cent, of Alcohol, in order better to preserve the preparation. 
Vinum — 

Aloes (U. S. P. 1880). — Representing 6 per cent, of Aloes 
with Aromatics. 

Aurantii. — Sherry Wine flavored with Orange. 

Aurantii Compositum (Elixir Aurantiorum Compositum). — A 
combination of Bitter Orange Peel, Absinthium, Menyanthes, 
Cascarilla, Cinnamon, and Gentian, in Sherry Wine. Useful 
as a stomachic tonic in doses of 1 fluidrachm (4 Cc). 

Carnis (Beef and Wine). — Each fluidrachm (4 Cc) represents 
2 grains (0.12) of Extract of Beef. 

The Extract of Beef in this and similar preparations is that which is pre- 
pared by Liebig's method. 

Carnis et Ferri (Beef, Wine, and Iron). — Each fluidrachm 
(4 Cc.) represents 2 grains (0.12) of Extract of Beef and 
2 minims (0.12) Tincture of Citro-chloride ("Tasteless" 
Tincture) of Iron. 

Carnis, Ferri et Cinchona (Beef, Wine, Iron, and Cinchona). 
— Each fluidrachm (4 Cc.) represents 2 grains (0.12) Extract 
of Beef, 2 minims (0.2) Tincture Citro-chloride of Iron, and 
small quantities of Cinchona alkaloids, in Angelica Wine. 

Coc,e (Erythroxyli). — Each fluidounce (30 Cc.) represents 
30 grains (2 Gm.) of Coca in Claret Wine. 
1 



98 A TEXT-BOOK OF MATERIA MEDICA. 

Vinum — 

CoC/E Aromaticum. — Each fluidounce (30 Cc.) represents 30 

grains (2 Gm.) of Coca with Aromatics. 
Fraxini Americans (White Ash). — Each fluidrachm (4 Cc.) 

represents 30 grains (2 Gm.) of Fraxinus (bark). 
Pepsini (Pepsin). — Each fluidrachm (4 Cc.) represents 1 grain 

(0.06) of Pepsin. 
Picis (Tar). — A saturated solution of Tar, in Sherry Wine. 
Pruni Virginians (Wild Cherry). — Each fluidrachm (4 Cc.) 

represents 15 grains (1 Gm.) of Wild Cherry, in Angelica 

Wine. 
Pruni Virginians Ferratum (Wild Cherry, Ferrated). — Each 

fluidrachm (4 Cc.) represents 5 minims (0.3 Cc.) of Tincture 

of Citro-chloride of Iron and 1 3^ grains (0.9 Gm.) of Wild 

Cherry, in Angelica Wine. 
Rhei (U. S. P. 1880). — Representing 10 per cent, of Rhubarb 

and 1 per cent, of Calamus. 

TINCTURE— TINCTURES. 

Tinctures are liquid preparations made by the extraction of 
Drugs with menstrua of Alcohol and Water in various propor- 
tions. They are prepared by maceration and filtration or by perco- 
lation (the tinctures of iodine and nux vomica are made by simple 
solution). 

In the Eighth Decennial (1900) Revision of the United States 
Pharmacopoeia a number of the tinctures have been changed in 
strength to correspond with the tinctures used in other countries. 
For the following, also, assay processes have been introduced: 
Aconite, Belladonna Leaves, Cinchona, Colchicum Seed, Hydrastis, 
Hyoscyamus, Iodine, Nux Vomica, Opium, Deodorized Opium, 
Physostigma, and Stramonium. 

Tincturae Herbarum Recentium. — Tinctures of Fresh Herbs, 
or " Green Tinctures," similar to the Homoeopathic or so-called 
" German Tinctures;' also to the specific tinctures of the Eclectics, 
when not otherwise directed are to be prepared by the following 
genera] formula: 

'-■ of the fresfa herb, cut, bruised, or crushed, 50 Gm. ; macerate for fourteen days 
>hol IOC Cc.J express the liquid and filter. 



EXTRACTIVE PREPARATIONS. 



99 



Tinctures of the U. S. P. 



Gm. 



Name. 
Tinctura — 

Aconiti 

Aloes \ 

Aloes et Myrrhas . . \ 

Arnicas 

Asafoetidas 

Aurantii Amari . . . 
Aurantii Dulcis . . . 
Belladonnas Foliorum . 
Benzoini 

Benzoini Composita i 
(Turlington's Bal- \ 
sam). 

Calendulas 

Calumbae ...... 

Cannabis Indicae . . . 

Cantharidis 

Capsici 

Cardamomi 



Drug. 



Cardamomi 
Composita 



Cimicifugas 
Cinchonas . 



}■ 



Cinchonas Composita 
(Huxham's Tinc- 
ture). 

Cinnamomi .... 
Colchici Seminis . . . 

Digitalis 

Ferri Chloridi .... 
Gallas 

Gambir Composita . j 

Gelsemii 

Gentianas Composita -j 

Guaiaci 

Guaiaci Ammoniata . 

Hydrastis 

Hyoscyami 



ioo Cc. 

Root 10 

Aloes 10 "> 

Licorice 20 J 

Aloes 10 ^ 

Myrrh 10 j- 

Licorice 10 J 

Flowers 20 

Gum resin 20 

Bitter Orange peel .... 20 

Sweet 50 

Leaves 10 

Balsam 20 

Benzoin 12 

Storax 8 

Tolu 4 

Aloes 2 _ 

Florets 20 

Root 20 

Flower tops 10 

Insect 10 

Fruit 10 

Fruit 20 

Cardamom 2.5 

Saigon Cinnam 2.5 

Caraway 1.2 

Cochineal . 0.5 

Glycerin 5 

Rhizome 20 

Bark 20 

Red Cinchona 10 

Bitter Orange peel .... 8 

Serpentaria 2 

Glycerin 7.5 

Saigon 20 

Seed 10 

Leaves 10 

Solution 35 Cc. 

Nutgall 20 

Gambir 5 "» 

Saigon Cinnam 2.5 i 

Root 10 

Gentian 10 

Bitter Orange peel .... 

Cardamom 

Resin 20 

Resin 20 

Rhizome 20 

Herb 10 





U. S. P. 


Menstrua. 


Average Dose. 


Alcohol, 
per cent. 




Cc. Min. 


70 


O.6 IO 



il 



50 



75 



100 



5o 



IOO 

67 
67 

67 
60 
50 
65 

90 
50 

65 

60 

IOO 

65 

50 



2. 
2. 
I. 

0.5 

4- 

4- 
05 



30 



30 



50 


I. 


15 


IOO 


I. 


15 


60 


4. 


60 


IOO 


4. 


60 


50 


0.5 


8 


IOO 


I. 


15 



30 



IOO 


2. 


30 


60 


4- 


60 


IOO 


0.6 


10 


IOO 


o-3 


5 


95 


05 


8 


5o 


4. 


60 



60 



60 
60 



60 

30 
30 
15 

8 
60 

60 

8 

4. 60 

4. 60 

2. 30 

4. 60 

1. 15 



IOO 



A TEXT-BOOK OF MATERIA MEDICA. 



Name. 



Tinctura- 
Iodi 



Drug. 



f Iodine . . . 

I Potass. Iodide 

_ .. f Ipecac . . . 
Ipecacuanha? et Opii \ Jt. . , 
r I Opium deod. 

Kino Insp. juice 

Krameria? Rhatany . . 

Lactucarii Insp. juice 

Oil Lavender 

Oil Rosemary 

j Cinnamon 
Lavandulae Composita \ p. 



| Nutmeg . . 

I Red Saunders 

Limonis Corticis . . . Fresh peel . 

Lobelia? Herb .... 



Moschi Musk . . . 

Myrrhae Gum resin 

Nucis Vomica? .... Extract . . . 

Opii Gran. Opium 

Opium pulv. 



Acid Benzoic 
- Camphor . . 

Oil Anise . . 
k Glycerin . . 

Gran. Opium 

Calabar Bean 



Opii Camphorata 
(Paregoric). 

Opii Deodorata 
Physostigmatis 

Pyrethri Pellitory . 

Qnassise Wood . . 

Quillajae Soap Bark 

{Rhubarb . 
Cardamom 
Glycerin . 
f Rhubarb . 
Cinnamon 
Cloves . . 
Nutmeg . 
Glycerin . 

Sanguinaria,- Blood-root 

Sail..- Squill . . 

Ser]>entari:.: Rhizome . 

Stranionii Leaves . . 

Strophaathi Seed . . . 

Tolutanu Tola . . . 

Valerianae Root . . . 

\mmoniat •• Root . . . 
Fruit . . . 

Rhizome . 

Ginger . . 

'• Expo totmnt. 



Rhei Aromatica 
(for syrup). 









U. S. P. 


Gm. Menstrua 


Average Dose. 


in Alcohol, 
700 Cc. per cent. 






Cc 


Min. 


5} « 


O.I 


*y* 


::} so 


0.5 


8 


5 65 


4- 


60 


20 50 


4- 


60 


50 50 


2. 


30 


0.8 - 








0.2 








2. 


I 75 


2. 


30 


0.5 








1. 








1. J 








50 IOO 






10 50 


{;.- 


I5 l 

60 2 


5 5o 


4- 


60 


20 IOO 


I. 


!5 


2 75 


0.6 


10 


10 50 


°-5 


8 


0.4] 








0.4 








0.4 


' 50 


8. 


120 


0.4 








4 J 








10 20 


0.5 


8 


10 IOO 


I. 


15 


20 IOO 






20 35 


2. 


30 


20 35 






20 ) 

4f 50 

10 J 






4. 


60 


20" 








4 








4 


50 


2. 


30 


2 








10 j 








10 60 


I. 


15 


10 75 


I. 


15 


20 65 


4- 


60 


10 50 


0.5 


8 


10 65 


o-5 


8 


20 IOO 


2. 


30 


20 75 


4- 


60 


20 . . 


2. 


30 


10 65 






10 IOO 


I. 


15 


20 IOO 


2. 


30 


imeti 


c. 









EXTRA CTI VE PRE PAR A TIONS. 1 01 

Unofficial Tinctures of the National Formulary. 
Tinctura— 

Amara (Bitter Tincture, Ph. Ger.). — Containing Gentian, Cen- 
taury, Bitter Orange Peel, Orange Berries, and Zedoary. 

Antacrida (Dysmenorrhcea Mixture ; Fenner's Guaiac Mix- 
ture). — A mixture of Guaiac, Canada Turpentine, Oil of Sas- 
safras, and \ grain (0.02) Corrosive Mercuric Chloride in each 
fluidrachm (4 Cc). Dose, from 10 to 20 minims (0.6 to 
1.3 Cc). 

Antiperiodica (Warburg's Tincture). — With Aloes: Rhubarb, 
Angelica Seed, of each, grains 56 (4.); Elecampane, Saf- 
fron, Fennel, of each, grains 28 (2.) ; Aloes (aq. ext), Gen- 
tian, Zedoary, Cubeb, Myrrh, White Agaric, Camphor, of 
each, grains 14 (1.); Quinine Sulphate, grains 160 (10.); 
Diluted Alcohol, enough to make fluidounces 16 (473 Cc). 

Antiperiodica (Warburg's). — The preceding without Aloes. 
Each fluidounce (30 Cc.) of either tincture contains 10 
grains (0.6) of Quinine Sulphate. 

Aromatica (Stomachic, Ph. Ger.). — A combination of Cinna- 
mon, Ginger, Galangal, Cloves, and Cardamom. 

Capsici et Myrrh^e (Hot Drops). — The preparation popularly 
known as " Number Six." 

Cinchona Detannat^e. — For admixture with preparations 
containing Iron. 

Conii (U. S. P. 1880). — Representing 1$ per cent, of Conium. 

Coto. — This preparation contains j\ grains (0.5) true Bolivian 
Bark in each fluidrachm (4 Cc). The Para Coto, frequently 
employed, differs considerably from the above. 

Ferri Chloridi ^Etherea (Bestucheff's Tincture ; Lamott's 
Drops, Ph. Ger.). — Each fluidrachm (4 Cc.) represents about 
\ grain (0.3) Metallic Iron. 

Ferri Citro-chloridi (Tasteless Tincture of Iron). — Practi- 
cally identical in the strength of Iron, but not in Alcohol, 
with the official Tincture of Chloride of Iron, containing an 
amount of Iron equivalent to j\ grains (0.5) of Dry Chloride 
of Iron in each fluidrachm (4 Cc). 

A convenient form of Iron for admixture with Tinctures 
of vegetable astringent drugs, such as Gentian and Cinchona, 
preparations of which it does not, unlike other iron com- 
pounds, discolor. 

Ferri Pomata (Ferrated Extract of Apples ; Malate of Iron, 
Ph. Ger.). — Each fluidrachm (4 Cc) represents about -| 
grain (0.025) of Metallic Iron. 



102 A TEXT-BOOK OF MATERIA MEDIC A. 

Tinctura — 

Guaiaci Composita (Dewees' Tincture of Guaiac). — Each 
fluidrachm (4 Cc.) represents 7 J grains (0.5) Guaiac. 

Ignati/E (U. S. P. 1880). — Representing 10 per cent, of 
Ignatia. 

Iodi (Churchill's). — A solution of 10 grains (0.6) Iodine in 
each fluidrachm (4 Cc), with Potassium Iodide in Alcohol. 
Not to be confounded with Churchill's Iodine Caustic 
(Liquor Iodi Causticus). 

Iodi Decolorata (Colorless Tincture of Iodine). — Contain- 
ing about I per cent, of Ammonium Iodide, with some other 
Iodine compounds, in alcoholic solution ; for external use. 

Jalaps (U. S. P. 1870). — Each fluidrachm (4 Cc.) represents 
about 10 grains (0.6) Jalap. 

Jalaps Composita. — Each fluidrachm (4 Cc.) represents j\ 
grains (0.5) Jalap and about 2 grains (0.12) Scammony. 

Kino Composita — 

Tinctures of Kino, Opium, each . . minims 180 12. Cc. 

Spirit of Camphor " 130 8.5 " 

Oil of Cloves " 2J 0.15 " 

Aromatic Spirit of Ammonia . . 15 1. " 

Cochineal grains 16 1. " 

Diluted Alcohol to make fluidounces 4 .... 120. " 

Each fluidrachm (4 Cc.) represents \ grain (0.03), each, 
of Kino and Opium. 

Papaveris (Poppy). — Each fluidrachm (4 Cc.) represents 30 
grains (2.) of Poppy (Capsule). 

Pectoralis (Bateman's Pectoral Drops). — A popular mixture 
of Opium, Catechu, Camphor, and Oil of Anise, containing 
2.V minims (0.15) Tincture of Opium (^ grain Pulv. Opium) 
in each fluidrachm (4 Cc). 

Persionis (Cudbear). — Intended as a coloring agent when a 
bright-red tint or color is to be produced, particularly in 
acid liquids. 

PERSIONIS Composita. — A mixture of Cudbear and Caramel, 
intended as a coloring agent when a brownish-red tint or 
color is to be reproduced. 

PlMPlNELLA (Pimpinella, Ph. Ger.).— Each fluidrachm (4 Cc). 
represents about 10 grains (0.6) Pimpinella Root. 

Rm.i AQUOSA (Rhubarb, Aqueous, Ph. Ger.). — Each fluid- 
drachm (4 Cc.) represents about 5? grains (0.4) of Rhu- 
barb, with alkalies, flavored with Cinnamon. 



EXTRACTIVE PREPARATIONS. 103 

Tinctura — 

Rhei et Gentians. — Each fluidram (4 Cc.) represents 5 
grains (0.3) of Rhubarb and 1 grain (0.06) of Gentian. 

Rhei Vinosa (Rhubarb, Vinous, Ph. Ger.). — Each fluidrachm 
(4 Cc.) represents about 5 grains (0.3) Rhubarb, with Bitter 
Orange and Cardamom, in Sweet Sherry Wine. 

Saponis Viridis Composita. — A solution of about 15 per 
cent, of Green Soap and 2 per cent, of Oil of Cade. 

Tincture ^Ethere^e (Ethereal Tinctures). — The drug, prop- 
erly comminuted, troy ounces 2 (60 Gm.) ; Stronger Ether, 
I volume ; Alcohol, 2 volumes ; enough to make fluid- 
ounces 16 (473 Cc). A general formula for the prepara- 
tion of Ethereal Tinctures of Belladonna, Castor, Digitalis, 
Lobelia, Valerian, and other drugs. Official in several 
European pharmacopoeias, and sometimes prescribed by 
foreign physicians. 

Tolutana Solubilis (Tolu, Soluble). — A so-called soluble 
essence of Tolu, for flavoring. 

Vanillini Composita. — A solution of Vanillin and Coumarin, 
intended for flavoring. 

ZedoarIjE Amara (Zedoary Comp.). — Similar to, but not 
identical with, the Tinctura Carminativa, Wedelii, etc., for- 
merly official in some Continental pharmacopoeias. 

Each fluidrachm (4 Cc.) represents 15 grains (1 Gm.) of 
Zedoary, j\ grains (0.5) of Aloes, and 3 J grains (0.25), each, 
of Rhubarb, Gentian, White Agaric, and Saffron. 

FLUIDEXTRACTA FLUIDEXTRACTS. 

Fluidextracts may be defined as a class of concentrated tinc- 
tures of such strength as to represent the drug, volume for weight. 
They are made by percolation, maceration, or digestion. 

The following is the process of percolation chiefly employed : 

In proceeding to percolate 100 Gm. of the drug, according to 
directions, the first 80 to 90 Cc. are reserved, and percolation con- 
tinued until the exhaustion is completed. The weak percolate is 
evaporated to a soft extract (the alcohol being recovered) and dis- 
solved in the reserved percolate. Sufficient menstruum is then 
added to make the product measure 100 Cc. 

The Pharmacopoeia gives assay processes for the Fluidextracts 
of Aconite, Belladonna Root, Cinchona, Coca, Colchicum Seed, 
Conium, Guarana, Hydrastis, Hyoscyamus, Ipecac, Nux Vomica, 
Pilocarpus, Scopola, and Stramonium. 



104 A TEXT-BOOK OF MATERIA MEDIC A. 

u. s. P. 

Average Dose. 

Official Name. Drug. Part. Cc. Minims 
Fluidextractum — 

Aconiti Aconitum Napellus Tuber . . . 0.05 I 

Apocyni Apocynum Cannabinum Root . . . . I. 15 

Aromaticum .... Pulvis Aromaticus I. 15 

Aurantii Araari . . Citrus vulgaris Rind. ... I. 15 

Belladonme Radicis. Atropa Belladonna Root. . . .0.05 1 

Berberkli- Berberis Aquifolium Rhizome . . 2. 30 

Buchu Barosma betulina Leaves ... 2. 30 

Calami Acorus Calamus Rhizome . . I. 15 

Calumbae Jateorrhiza palmata Root .... 2. 30 

Cannabis Indicae . . Cannabis sativa Fl. Tops . . 0.05 1 

Capsici Capsicum fastigiatum Fruit .... 0.05 I 

Chimaphilae .... Chimaphila umbellata Leaves ... 2. 30 

Chiratae Svvertia Chirata Plant. . . . 1. 15 

Cimicifugae .... Cimicifuga racemosa Rhizome . . I. 15 

Cinchonae Cinchona Calisaya Bark .... I. 15 

Cocae Erythroxylon Coca Leaves ... 2. 30 

Colchici Seminis . . Colchicum autumnale Seed .... 0.2 3 

Conii Conium maculatum PYuit . . . 0.2 3 

Convallariae .... Convallaria majalis Rhizome . . 0.5 8 

Cubebae Piper Cubeba Fruit . . . . 1. 15 

Cypripedii .... Cypripedium pubescens Rhizome . . I. 15 

Digitalis Digitalis purpurea Leaves . . . 0.05 1 

Ergotae Claviceps purpurea Sclerotium . 2. 30 

Eriodictyi Eriodictyon glutinosum Leaves . . . 1. 15 

Eucalypti Eucalyptus globulus Leaves ... 2. 30 

Euonymi Euonymus atropurpureus .... Bark .... 0.5 8 

Eupatorii Eupatorium perfoliatum . . . . Herb. ... 2. 30 

Jran^ulae .... Rhamnus Frangula Bark . . . . 1. 15 

Gelsemii Gelsemium sempervirens .... Rhizome . . 0.05 1 

Gentianae Gentiana lutea Root . . . . 1. 15 

Geranii Geranium maculatum Rhizome . . 1. 15 

Glycyrrhizae .... Glycyrrhiza glabra Root .... 2. 30 

Granati Punica Granatum Bark .... 2. 30 

Grindelise Grindelia robusta Leaves ... 2. 30 

Guaranse Paullinia Cupana Seeds ... 2. 30 

Hamamelidis . . . Ilamamelis Virginiana Leaves ... 2. 30 

rautia Hydrastis Canadensis Rhizome . . 2. 30 

Hyoscyami .... Hyoscyamus niger Herb. . . .0.2 3 

!Root : 

Emetic . . I. 15 

Lxpectorant 0.05 1 

Krameria triandra Root . . . . 1. 15 

I ... Arctium Lappa Root .... 2. 30 

. . Veronica Virginica Rhizome . . 1. 15 

. . Lobelia inflata Herb .... 0.5 8 

. Humulus Lupulus Powder. . . 0.5 8 

. . Piper angustifolium Leaves ... 4. 60 



EXTRACTIVE PREPARATIONS. 105 

u. s. P. 

Average Dose. 

Official Name. Drug. Part. Cc. Minims. 

Fluidextractum — 

Mezerii Daphne Mezereum Bark .... 

Nucis Vomicae . . . Strychnos Nux-vomica Seed .... 0.05 I 

Pareirse Chondodendrum tomentosum . . Root .... 2. 30 

r Root : 

Phytolacca .... Phytolacca decandra 1 Emetic . . I. 15 

I Alterative .0.1 1)4 

Pilocarpi Pilocarpus Jaborandi Leaves ... 2. 30 

Podophylli .... Podophyllum pel tatum Rhizome . . o. 5 8 

Pruni Virginianae . Prunus serotina Bark .... 2. 30 

Quassiae Picraena excelsa Wood ... 0.5 8 

Quillajae Quillaja saponaria Bark .... 0.2 3 

Rhamni Purshianae . (Cascara sagrada) Bark .... I. 15 

f Rhamnus Purshiana, ^ 

Rhamni Purshianae ^,, , . 

1 Glycyrrhiza, L I. 15 

Aromaticum . . j ^ . . . x e I 

v Compound spirit of orange J 

Rhei Rheum officinale Root . . . . I. 15 

Rhois Glabrae . . . Rhus glabra Leaves . . . I. 15 

Rosae Rosa Gallica Petals ... 2. 30 

Rubi Rubus villosus Root Bark . I. 15 

Sabinae Juniperus Sabina Tops .... 0.3 5 

Sanguinariae .... Sanguinaria Canadensis Rhizome . . o. I i}4 

Sarsaparillae .... Smilax officinalis, etc Root .... 2. 30 

f Sarsaparilla, 75 ] 

Glycyrrhiza, 12 I 

Sassafras, 10 [ 3° 

Mezereum, 3 J 

Scillae Urginea maritima Bulb . . . . o. 1 i*^ 

Scopola Scopola Carniolica Rhizome . . 0.05 1 

Scutellariae .... Scutellaria lateriflora Herb. . . . 1. 15 

Senegal Polygala Senega Root . . . . 1. 15 

Sennae Cassia acutifolia and angustifol. . Leaves ... 2. 30 

Serpentariae .... Aristolochia Serpentaria Rhizome . . 1. 15 

Spigeliae Spigelia Marilandica Rhizome . . 4. 60 

Staphisagria .... Delphinium Staphisagria .... Seed .... 0.05 I 

Stillingiae Stillingia sylvatica Root .... 2. 30 

Stramonii Datura Stramonium Leaves . . . 0.05 1 

Sumbul (undetermined) Rhizome . . 2. 30 

Taraxaci Taraxacum officinale Root .... 8. 120 

Tritici Agropyrum repens Rhizome . . 8. 120 

Uvae Ursi Arctostaphylos Uva Ursi .... Leaves ... 2. 30 

Valerianae Valeriana officinalis Rhizome . . 2. 30 

Veratri Viridis . . . Veratrum viride Rhizome . . o. I \y z 

Viburni Opuli . . . (Cramp bark) , . Bark .... 2. 30 

Viburni Prunifolii . (Black haw) Bark .... 2. 30 

Xanthoxyli .... Xanthoxylum Americanum . . . Bark .... 2. 30 

Zingiberis Zingiber officinale Rhizome . . 1. 15 



Sarsaparillae Com- 
positum . . . 



106 A TEXT-BOOK OF MATERIA MEDICA. 

Unofficial Fluidexlracts of the National Formulary. 

Unless otherwise indicated, the dose of the following Fluid- 
extracts is from \ to i fluidram (2 to 4 Cc): 

Fluidextractum — 

Adonidis. — Root of Adonis vernalis L. (Bird's Eye). 
Aletridis. — Rhizome of Aletris farinosa L. (Stargrass). 
Angelica Radicis. — Root of Archangelica L. (Angelica). 
Apii Graveolentis. — Seed of Apium graveolens L. (Celery). 
Aralle Racemose. — Root of Aralia racemosa L. (American 

Spikenard). 
Arnica Florum. — Flower heads of Arnica montana L. (Ar- 
nica). 
Berberidis Vulgaris. — Bark of the root of Berberis vulgaris 

L. (Barberry). 
Boldi. — Leaves of Peumus Boldus Molina (Boldo). 
Buchu Compositum. — A combination of Buchu, 10; Cubeb, 

2 ; Juniper, 2 ; Uva Ursi, 2 parts. 
Calendula. — Flowering herb of Calendula officinalis L. 

(Marigold). 
Camelli.e. — Leaves of Camellia Thea Link (Tea). The best 

quality of commercial black tea, " Formosa Oolong," to be 

employed for this preparation. 
Caulophylli. — Rhizome and rootlets of Caulophyllum thalic- 

troides Mich. (Blue Cohosh). 
Coffe.-e Viridis. — Unroasted seeds of Cofifea Arabica L. 
Coffe.e TosT/E. — Roasted seeds of Coffea Arabica L. 

The N. F. recommends equal portions of Java and Mocha 

to be employed in preparing the Fluid Extracts of Coffee. 
Convallari/K Florum. — Flowers of Convallaria majalis L. 

(Lily of the Valley). 
Corns. — Rhizome of Coptis trifolia Salisb. (Goldthread). 
Counts Circinat.k. — Bark of Cornus circinata L'Her. (Green 

Osier.) 
Cornus Florida (U. S. P. 1880). — Dogwood Bark. 
CORYDALIS. — Tubers of Dicentra Canadensis De C. (Turkey 

Corn). 
COTO. — Coto bark, undetermined tree. Dose, from 5 to 15 

minims (0.3 to I Cc). 
I 1. — Thallus of Pucus vesiculosus L. (Bladder-wrack). 



• 



EXTRACTIVE PREPARATIONS. 107 

Fluidextractum — 

Helianthemi. — Herb of Helianthemum Canadense Mich. 
(Frost-wort). 

Humuli. — Strobiles of Humulus Lupulus L. (Hops). 

Hydrangea. — Root of Hydrangea arborescens L. (Seven 
Barks). 

Jalaps. — Tuber of Exogonium purga Benth. (Jalap). Dose, 
from 15 to 20 minims (1 to 1.3 Cc). 

Juglandis. — Bark of the root of Juglans cinerea L. (Butternut). 

Juniperi. — Fruit of Juniperus communis L. 

Kava. — Root of Piper methysticum Forster (Kava ; Kava- 
Kava). 

Lactucarii (U. S. P. 1880). — Insp. juice of Lactuca virosa L. 

Malti.-— (Fluid Extract of Malt). 

Menyanthis. — Leaves of Menyanthes trifoliata L. (Buckbean ; 
Trifolium fibrinum, Ph. G.). 

Mezerei (U. S. P. 1880). — Bark of Daphne Mezereum L. 
Dose, from 5 to 10 minims (0.3-0.6 Cc). 

Petroselini Radicis. — Root of Petroselinum sativum Hoff- 
man (Parsley). 

QuillajjE. — Bark of Quillaja Saponaria Molina (Soap Bark). 

Rhamni Purshian^e Aromaticum. — Cascara Sagrada de- 
prived of its bitter taste. 

Rhei Aromaticum. — A combination of Rhubarb, Cinnamon, 
Cloves, and Nutmeg. 

Senn,e Deodoratum (Aqueous Fluid Extract of Senna).— 
This preparation is free from the objectionable " griping" 
qualities of the ordinary fluid extract. 

SterculIjE. — Seeds of Sterculia acuminata R. Brown (Cola 
or Kola). 

Stilllingi^e Compositum (Stillingia Comp.). — Stillingia, Cory- 
dalis, each, 4 parts ; Iris, Sambucus, Chimaphila, each, 2 
parts ; Coriander, Xanthoxylum Berries, each, 1 part. 

Trillii. — Rhizome of Trillium erectum L. (Bethroot). 

Turners. — Leaves of Turnera microphylla De C. (Damiana). 

Urtic.e. — Root of Urtica dioica L. (Nettle). 

Verbasci. — Leaves (and flowers) of Verbascum Thapsus L. 

Verbena. — Root of Verbena hastata L. (Vervain). 

Ze,e. — Stigmatum Maydis ; Corn Silk ; Stigmata of Zea Mays 
L. (Indian Corn). 



io8 



A TEXT-BOOK OF MATERIA MEDICA. 



EXTRACTA EXTRACTS. 

Extracts — or " solid " extracts, as they are termed, to distinguish 
them from fluidextracts — are the soluble principles of vegetable 
drugs, extracted and concentrated by evaporation to a soft solid or 
a plastic mass of pilular consistence, or dried and reduced to 
powder. 

Table Showing the Drug-strength a?id the Average Doses of the 
Official Extracts. 



Extractum. 



Part. 



Aloes (aqueous) 

Belladonna; Fol Leaves . . 

Cannabis Indicae Herb . . 

Cimicifugae Rhizome . 

Colchici Cormi (acetic) Conn . . 

Colocynthidis ( powder] Fruit. . . 

r i *u-j- r ( E xt - Colocynth, 16 ; Carda- 

Colocvntnidis Com- c ' A1 ' „ ' c 

, A mom, o ; Aloes, so ; Soap, 
positum powder i ] c \r F 

' { Scammony, each, 14. 

Digitalis Leaves . . 

Ergotae Sclerotium 

Eu nymi Bark . . . , 

Gentianae (aqueous) Root . . . 

Glycyrrhizae (stick) ........ Root . . . . 

Glvcyrrhizae Purum (ammon. > . . . . Root . . . . 

Haematoxyli (aqueous) • Logwood . 

Hyoscyami Herb . . . . 

Krameriae (aqueous) Root . . . 

Leptandrae Root . . . . 

Malti Liquid . . . 

Xucis Vomicae (powder) Seed . . . . 

Opii (powder) 

Physostigmatis Calabar bean 

Quassiae (aqueous Wood . . . 

Rharnni Purshianae Bark . . . . 

Rhei Root . . . , 

Scopola Rhizome . . 

Stramonii Leaves . . . 

Sombol Rhizome . , 

Taraxaci (aqueous) Root . . . . 



Parts of 






Drug in 


Dose of Extract. 


1 part of 






Extract 
(Approx- 










imate.) 


Grains. 


Gm. 


2 


2 


O.125 


5 


l 
5 


o.or 


10 


1 
3" 


O.OI 


10 


4 


0.25 


3 


1 


0.065 


6 


$ 


0.03 




1\ 


o-5 


4 


1 
f 


O.OI 


5 


4 


0.25 


5 


2 


0.125 


4 


4 


0.25 


3 


15 


I. 


3 


J 5 


I. 


4 


15 


I. 


6 




0.065 


5 


7* 


0.5 


5* 


4 


0.25 




31V 


16 Cc. 


10 


i 


0.015 


T 1 


$ 


0.03 


20 


J 


0.008 


25 


1 


0.065 


4 


4 


0.25 


3 


4 


0.25 


5 


t 


O.OI 


10 


I 


O.OI 




4 


0.25 


3 


"5 


1- 



The strength of an extract depends upon the amount of the 
crude drug it represents. Hence, the smaller the percentage of 
extract obtained from a drug, the greater the relative strength 
of the extract, provided that the drug be exhausted with menstrua 
adapt ure all the active principles in this form. 

The yield of extract is influenced by the character of the men- 
struum employed. As a general rule, the more aqueous the men- 



EXTRA CTI VE PRE PA RA TIONS. 109 

strua, the greater the yield of extract ; conversely, the more alco- 
holic the menstrua, the smaller the yield of extract. To obtain the 
extracts, therefore, of official strength it is necessary to use official 
menstrua in the extraction. 

Thus the extracts of different drugs are as many times stronger 
than the drug as the quotient obtained by dividing the drug at 
100 by the percentage yield. For example : Podophyllum yields 
10 per cent, of extract ; then 100 -*- 10 = 10 ; that is, the extract is 
ten times as strong as the drug and the fluid extract, or 0.1 of the 
extract represents 1 Gm. of the drug or 1 Cc. of the fluid extract. 
The drug-strengths of the official Extracts, calculated by this 
method, as well as their relative doses based upon the amounts of 
drug they represent, are exhibited in the table given on page 109. 

The official Extracts are made by extraction with alcoholic 
menstrua or with water, sometimes by the addition of acid or alkali. 

The Extracts of Cimicifuga, Colocynth, Colocynth Compound, 
Euonymus, Leptandra, Nux Vomica, Opium, Physostigma, Quassia, 
and Rhamnus Purshiana, are in powdered form ; the others are of 
pilular consistence. 

The Pharmacopoeia gives assay processes for the following 
extracts : Belladonna Leaves, Colchicum Corm, Hyoscyamus, Nux 
Vomica, Opium, Physostigma, Scopola, and Stramonium. 



Extractum Ferri Pomatum, N. F. — Ferri Malas Crudus (Fer~ 

rated Extract of Apples, Ph. Ger.). 
Extractum Glycyrrhiz^e Depuratum, N. F. — Succus Liqui- 

ritiae, Ph. Ger. (Purified Extract of Liquorice). 

OLEORESIN/E— OLEORESINS. 

To natural Oleoresins, derived as plant-exudations, belong the 
Turpentines and the Pitches. From similar exudations are ob- 
tained the Gum Resins, mixtures of Gum and Resins and sometimes 
Volatile Oils ; also the Balsams, which are Resins or Oleoresins 
associated with Benzoic or Cinnamic Acid. These are treated 
under their respective Drugs. 

The pharmaceutical Oleoresins are semi-liquid extracts, obtained 
by exhausting oleoresinous drugs with acetone (alcohol is employed 
in the manufacture of Oleoresin of Cubeb). 

This extracts fixed and volatile oils and resin ; these principles 
constitute therefore the oleoresins, which sometimes also contain 
other active matter in solution or suspension. 



HO A TEXT-BOOK OF MATERIA MEDICA. 

The six following are official : 

Oleoresina — Gm. Gr. 
Aspidii ; separates in two layers, to be mixed 

when used 2. 30 

Capsici ; separates fat, used only as corrective 0.03 \ 

Cubebae ; separates wax 0.5 7J 

Lupulini 0.2 3 

Piperis ; separates piperine, to be rejected . . 0.03 J 

Zingiberis 0.03 J 

RESINS— RESINS. 

The official Resins may be divided into the (1) Natural Resins, 
(2) Resins obtained from Oleoresins by separating the Volatile Oil 
by distillation, and (3) the Pharmaceutical Resins, prepared by pre- 
cipitation. 

When a concentrated tincture of a resinous drug is poured into a 
large quantity of cold water, the resinous matter becomes insoluble 
and is precipitated ; this, after being washed, dried, and sometimes 
powdered, is termed a resin. 

Resins are usually soluble in alkalies and insoluble in acids 
(dilute) ; for this reason the water used for precipitation is some- 
times rendered slightly acid to favor the separation. 

The three following are official : 

Per cent, yield Dose. 

fro?n Drug. , * s 

Resina — About Gm. Gr. 

Jalapa,- 15 0.125 2 

1 purgative 

Jz * 

0.005 tV 

Scammonii 65 0.2 3 

Resina and Resina Copaibae are obtained as residue in the dis- 
tillation of the respective Oleoresins, Turpentine and Copaiba. 
The natural Resins are obtained as exudates — e.g. R. Guaiaci. 

The terms resin, resinoid, and concentration are also applied to a 
class of preparations used by eclectic physicians, prepared by this 
general process with some modifications. (See U. S. and Am. Disp.) 
They are named after their respective Drugs with the ending in, as 
m Giucosides, and must not be confused with the latter. While 
the GlllCOSldes are usually the active medicinal constituents repre- 
senting the drug, the resinoids, with the exception of those made 



SOLID MIXTURES FOR INTERNAL USE. Ill 

from drugs whose active principles are resins, such as Cimicifuga 
and Podophyllum, are more or less inert, unreliable mixtures, too 
indefinite in their composition and strength for medicinal use. 



SOLID MIXTURES FOR INTERNAL USE. 

Mixtures of Solids for internal use embrace the following 
classes of preparations : Powders, Effervescent Salts, Confections, 
Troches, Masses, and Pills. 

Powders are substances reduced to a fine pulverulent condition 
to favor their administration and solution or absorption. A powder 
may be simple, such as a powdered drug, Pulvis opii, or a pow- 
dered salt — i. e. Quinince sulphas ; or it may be compound, a mix- 
ture of several substances. 

Sparingly soluble substances, when finely powdered (impalpable) 
and thoroughly mixed by trituration in a mortar with some inert 
powder (diluent) such as Milk Sugar, are rendered more soluble, 
since a greater surface is exposed to the solvent action of the 
liquids of the body, and prompter and fuller effects are obtained. 
The potency of calomel, of the resins, and of alkaloids is in this 
way considerably increased within certain limits, but not to the 
unreasonable extent advocated by Homoeopathic pharmacy, in 
which this process is carried to a reductio ad absurdum. It is an 
excellent and convenient method for dispensing and administering 
the more potent agents, such as arsenous acid, mercury com- 
pounds, and the alkaloids. Substances triturated in this way have 
been called Triturations, for whose preparation the U. S. P. gives a 
general formula. ( Tfituratio Elaterini is the only official trituration.) : 

Take of the substance, for example, Elaterin . . . I Gm. 
Milk Sugar, in fine powder 9 Gm. 

First thoroughly triturate the medicinal substance (Elaterin) 
with an equal weight of Milk Sugar, then add the remainder of the 
Milk Sugar, and mix thoroughly by trituration (for about ten 
minutes). 

Unless otherwise specified, triturations should be of the official 
strength — i. e. 10 per cent, of the drug. 

By the addition of about an equal weight of Alcohol to the 
triturate it becomes a soft mass, which, after being moulded into 
disks of about 1 grain (0.06 Gm.) each, after the evaporation of the 



112 A TEXT-BOOK OF MATERIA MEDIC A. 

Alcohol, furnishes the so-called Tablet Triturates. These afford 
a convenient method of medication for such substances as are 
adapted to trituration, which is, however, confined, as indicated, 
to a comparatively limited number of agents. To represent in the 
form of these tablets every kind of medicinal agent of volatile cha- 
racter, or drugs otherwise susceptible to change through the inevi- 
table exposure to the atmosphere to which every such mixture is 
liable, is simply to invite error in practice. These tablets, more- 
over, with certain chemical substances, undergo chemical changes 
which render them entirely insoluble, and thus practically inert. 
In order to be effective and otherwise reliable, they should be pre- 
pared extemporaneously by the pharmacist, in order to ensure 
their solubility. 

They should always be dissolved in a little water before they 
are administered. 

When it is desired to obtain a mild and prolonged local effect 
of a medicinal agent in the mouth or throat, the substance is made 
into a soft mass {confection) with a diluent and excipient, Sugar and 
Mucilage, and flavor, and formed into round or oval-shaped disks, 
weighing from 8 to 30 grains (-J- to 2 Gm.), called variously Lozenges, 
Troches, and Pastils. 

Troches. — When these are allowed to dissolve slowly in the 
mouth the diluent serves as a vehicle for the medicinal agent, and 
a gradual prolonged effect is obtained upon the mucous surfaces. 
This form of medication is adapted only to astringents, antacids, 
expectorants, and stomachics consisting of substances not especi- 
ally disagreeable to the palate. 

Lozenges are not intended to be swallowed, nor adapted to 
exceedingly volatile, caustic, irritant, or otherwise unpalatable sub- 
stances. For ingestion, medicinal agents should be made into a 
Mass (massd) with an excipient, and formed into small spheres, or 
balls, as a rule not over 5 grains (0.3 Gm.) in weight, to be swallowed 
and slowly dissolved in the stomach or intestines. Such prepara- 
tions arc the so-called Pills {Pilulce, from pila % ball). The medicinal 
substance may also be divided and placed in Gelatin Capsules or in 
Kit e-flour Cachets. 

PULVER ES — row DERS. 

The official Powders are impalpable mixtures of one or more 
drugs, usually with some nearly inert substance, such as 
ir, as a diluent, and Aromatics. 

Thc\- arc made by trituration. 



SOLID MIXTURES FOR INTERNAL USE. 1 13 

Pulvis— Gm - in I0 °' 

Acetanilidi Compositus . . acetanilide 70, caffein 10. 

sodium bicarbonate 20. 

Aromaticus . . cinnamon (Saigon), ginger, each 35. 

cardamom (seed), nutmeg, each 15. 

Cretae Compositus . acacia p. 20; sugar 50; prep, chalk 30. 

Glycyrrhizae Compositus . . senna 1 8 ; glycyrrhiza 23.6 

fennel oil 0.4 ; sulphur, washed, 8 ; sugar 50. 

Ipecacuanhae et Opii . . ipecac, opium pulv., each 10. 

(Dover's Powder) sugar of milk 80. 

Jalapae Compositus . . potass, bitartrate 65 ; jalap 35. 

Morphinae Compositus . . camphor 32 ; morphine 

(Tully's Powder) sulph. 1.5 

calcium carb., precip. 33.5 ; glycyrrhiza p. 33. 
Rhei Compositus . magnesium oxide 65 ; ginger 10 ; 

rhubarb 25. 

Tor 12 pow. ; in each 
Gm. Gr. 

EfTervescens Compositus . . (Seidlitz Powder) 

potassium and sodium tartrate 93 120 
sodium bicarbonate 3 1 40 

acid tartaric 27 3$ 

Many methods are in use for the purpose of disguising the taste 
of disagreeable remedies in the powder form. Of these the most 
elegant and effective method is that of enclosing the powder in a 
cachet or wafer. Originally wafers were made of starch-paste in 
thin sheets ; a piece about 0.5 dcm. (2 inches) square, immersed 
in water for a minute, being placed in a spoon, the powder poured 
into it, and then enwrapped by folding up the edges and swallowed 
with a little water. The cachets or " konseals " are wafer-disks 
consisting of two concentric halves, one of which is filled with the 
powder, and the other half attached by moistening the edge and 
pressing the edges together by means of various devices. These 
cachets are of three sizes, the largest holding 5 grains (0.3) Quinine 
Sulphate. After a moment's immersion in water they can be swal- 
lowed without any effort. 

Unofficial Powders of the N. F. 

Pulvis — 

Acacia Compositus (Pulvis Gummosus, Ph. Ger.). 
Acetanilidi Compositus. — Containing 50 per cent. Acetan- 

8 



114 A TEXT-BOOK OF MATERIA MEDIC A. 

Pulvis — 

ilid, 2 per cent. Caffeine, with Tartaric Acid and Sodium 
Bicarbonate. 

Aloes et Canell^e (Hiera Picra). 

Amygdalae Compositus (Almonds Comp.) — A mixture of 
Sweet Almond, Sugar, and Acacia, in fine powder; 180 
grains (10 Gm.), triturated with Water, yield about 4 fluid- 
ounces (119 Cc.) of Emulsum Amygdalae. 

Anticatarrhalis (Catarrh Snuff.) — Hydrochlorate of Mor- 
phine, 1 part; Acacia, 60 parts; Subnitrate of Bismuth, 180 
parts, in fine powder. 

Catechu Compositus (Compound Powder of Catechu, Ph. Br.). 
— Catechu, 4 parts ; Kino, 2 parts ; Krameria, 2 parts ; 
Cinnamon, 1 part ; Nutmeg, I part. 

Cret/E Aromaticus. — A mixture of Cinnamon, Saffron, Nut- 
meg, Cloves, Cardamon, prepared Chalk, and Sugar. 

Cret^e: Aromaticus cum Opio. — Aromatic Powder of Chalk, 
with 1 grain (0.06) of powdered Opium, in 40 grains (1.5) of 
the mixture. Official in the Ph. Br. 

Hydrargyri Chloridi Mitis et Jalap^e (Calomel and 
Jalap). — A mixture of Mild Chloride of Mercury, 10 grains 
(0.6), and Jalap, 20 grains (1.3). 

When " Calomel and Jalap " is prescribed for an adult, without any specifi- 
cation of quantities, the N. F. recommends that the above mixture be dispensed 
as one dose. 

Iodoformi Compositus (Iodoform and Naphthalin). — A mixture 
of Iodoform, 2 parts ; Boric Acid, 3 parts ; Naphthalin, 5 
parts ; with Oil of Bergamot, in fine powder. 

This powder is used in many cases where a diluted preparation of Iodo- 
form, for external purposes, is desired. The odor is masked both by the Oil 
of Hcrgamot and by the Naphthalin. 

Kino Compositus. — A mixture of Kino and Cinnamon, with I 
grain (0.06) of Powdered Opium in each 20 grains (1.3). 

Myrice Compositus (Composition Powder). — A mixture of 
Bayberry, Ginger, Capsicum, and Cloves. 

PANCREATICUS COMPOSITUS (Peptonizing Powder). — A mixture 
of 20 parts Pancreatin and 80 parts Sodium Bicarbonate; 
tains will peptonize 1 pint of milk. 

Pepsini Compositus (Pulvis Digestivus). — A mixture of Pep- 
sin, Pancreatin, Diastase, Lactic and Hydrochloric Acids, 
with Milk Sugar to represent the gastric juice. 



SOLID MIXTURES FOR INTERNAL USE. 1 15 

Pulvis — 

Rhei et Magnesia Anisatus (Compound Anise Powder.) — 
A mixture of Rhubarb, Heavy Magnesia, and Oil of Anise. 
Talci Salicylicus (Salicylated Powder of Talcum). — A mix- 
ture of Talcum with 3 per cent. Salicylic Acid and 10 per 
cent. Boric Acid, in fine powder. 

Powders are usually directed to be divided into papers (char- 
tulce) ; thus, for example, a formula for a prescription would be — 

Ify, Hydrargyri Chloridi Mitis . . 1. 

Sacchari Lactis 9. 

Misce cum trituratione et in chartulis No. x. divide. 

Encapsuling powders by filling them in gelatin capsules is a 
very convenient and elegant form of administration. No mixture 
which is desired to be given in the form of powder, however, should 
be made into a mass for facilitating the encapsuling process — 
a custom too frequently adopted. Many substances, especially 
Bismuth Subnitrate and Calomel, become exceedingly hard and 
quite insoluble when made into a mass. No dispenser should 
assume the prerogative of changing the form of medication pre- 
scribed. 

SALES EFFERVESCENTES EFFERVESCENT SALTS. 

These are granulated mixtures of Salts with Sugar and Sodium 
Bicarbonate and Tartaric Acid, which effervesce when the Salt is 
dissolved in Water and furnish agreeable aerated draughts. 

The following are official, the strength indicated being that con- 
tained in 60 grains (4 Gm.), a teaspoonful being the ordinary dose, 
dissolved in about 6 fluidounces (180 Cc.) of water: 

Gm. Gr. 

Caffeina Citrata Effervescens caffeine 0.16 2\ 

Lithii Citrata Effervescens ... lithium citrate 0.2 3 

Potassii Citras Effervescens . potassium citrate 0.8 12 

Sodii Phosphas Effervescens . sodium phosphate 0.8 12 

Effervescent Salts {Granular), N. F. 

The strength given for these is the quantity contained in 90 
grains (6 Gm.), which represents about the quantity of these Salts 
contained in a heaped teaspoonful of ordinary size, the average 
dose. 



Ii6 A TEXT-BOOK OF MATERIA MEDICA. 

Ferri et QuiNiNiE Citras Effervescens, i grain (0.06) Citrate 
of Iron and Quinine. 

Ferri Phosphas Effervescens, 2 grains (0.12) Phosphate of Iron. 

Potassii Bromidum Effervescens, 20 grains (1.3) Potassium Bro- 
mide. 

Potassii Bromidum cum Caffeina, 10 grains (0.6) Potassium Bro- 
mide and 1 grain (0.06) Caffeine. 

Sal Carolinus Factitius Effervescens (Effervescent Carlsbad 
Salt, artificial). — A solution of about 87 grains (5.5) in 6 fluid- 
ounces (178 Cc.) of Water represents an equal volume of 
Carlsbad Water (Sprudel). 

Sal Kissingensis Factitius Effervescens (Effervescent Kissingen 
Salt, artificial). — A solution of about 80 grains (5 Gm.) in 6 fluid- 
ounces (178 Cc.) represents an equal volume of Kissingen 
Water (Rakoczy). 

Sal Vichyanus Factitius Effervescens (Effervescent Vichy 
Salt, artificial). — A solution of about 57 grains (4 Gm.) in 6 
fluidounces (178 Cc.) of Water represents an equal volume of 
Vichy Water (Grand Grille). 

Salts {Non-effervescent). 

Sal Carolinus Factitius. — In two forms, Dry (Ph. Ger.) and 
Crystalline. A solution of about 16 grains (1 Gm.) of the Dry 
(27 grains (1.8) of the Crystalline) in 6 fluidounces (178 Cc.) 
of Water represents an equal volume of Carlsbad Water 
(Sprudel). 

Sal Kissingensis Factitius. — A solution of about 24 grains (1.5) 
in 6 fluidounces (178 Cc.) of Water represents an equal volume 
of Kissingen Water (Rakoczy). 

Sal Vichyanus Factitius. — A solution of about 14 grains (1 Gm.) 
in 7 fluidounces (207 Cc.) of Water represents an equal volume 
of Vichy Water (Grand Grille). 

CONFECTIONES— CONFECTIONS. 

Confections may be defined as flavored masses wherein the 
adhesive substance is Sugar in large proportions, serving as a 
vehicle for masking the taste of the drug. 

Confections, when made by beating a fresh drug, first reduced 
to pulp with sugar until of the proper consistence, are termed 
conserves. When made from powders or extracts they are called 
electuaru 

(July one representative of each class is official: 



SOLID MIXTURES FOR INTERNAL USE. 



117 



Gm. in 100 Cc, 

Confectio Rosae rose water 16, red rose 8. 

(Conserve of Rose) sugar 64, honey 12. 

( oil coriander 0.5, senna 10. 

Confectio Sennae . < cassia fistula 16, fig 12, tamarind 10. 
(Electuar. Sennce) \ prune 7, sugar 55.5, water to 100. 
The Confection of Senna is a very agreeable laxative, especially 
adapted for constipation in women and children. It is exceedingly 
agreeable to the taste. 

TROCHISCI— TROCHES. 

Troches, or lozenges, are confections made into various forms 
and then dried. 

The vehicle or excipient consists of Powdered Gum Tragacanth 
or Sugar with flavoring — in some cases orange flower water, in 
others tolu, nutmeg, vanilla, etc. 

The active ingredients are mixed with the diluent or vehicle and 
made into a plastic mass with the particular excipient, Water or 
Syrup. The mass is rolled out to the requisite thickness, and the 
disks formed by cutting through it with a punch or troche-cutter. 
The troches are then dried by exposure. 

The size and weight of the troche are regulated by the thickness 
of the mass and the diameter of the cutter. 

The official Troches vary in weight from Gm. 0.5 to 1.5. 







Act 


ive Drug. 




Gm. in 


Gm. in 


Grains in 




100 


each 


each 


Trochisci — 


Troches. 


Troche. 


Troche. 


Acidi Tannici 


6. 


O.06 


i Orange flor. 


Ammonii Chloridi .... 


10. 


O.I 


\\ Tolu. 


extract glycyrrhiza 


20. 


0.20 


3i 


Cubebae .... oleoresin 


2. 


0.02 


1 
3 


extract glycyrrhiza 


25- 


O.25 


4 


sassafras oil 


I. 


O.O I 


1 


Gambir gambir 


6. 


O.06 


i Orange flor. 


Glycyrrhizae et Opii 








ext. glycyrrhiza 


15. 


O.I5 


2 J Anise. 


powd. opium 


0.5 


O.OO5 


1 
12 


Krameriae .... extract 


6. 


O.06 


1 Orange flor. 


Potassii Chloratis .... 


15. 


O.I5 


2j 


Santonini 


3- 


0.3 


\ Orange flor. 


Sodii Bicarbonatis .... 


18. 


O.I8 


3 Nutmeg. 



Il8 A TEXT-BOOK OF MATERIA MEDIC A. 

Lozenges of Peppermint, Lemon, Musk, Vanilla, and Gaultheria 
may readily be prepared by saturating sugar lozenges with the 
respective essences or tinctures and permitting the alcohol to 
volatilize. 

MASS^E— MASSES. 

Masses are plastic mixtures of pilular consistence. They are 
made by incorporating the drug with adhesive substances, by chem- 
ical reaction, and sometimes by both processes. 

The Masses are intended to be formed into pills whenever they 
are to be dispensed. They are therefore often called Pil., Pilulce, 
instead of Massa. There are only two official : 

Massa Ferri Carbonatis f sodium carb. 46, ferrous sulph., 100 
(Vallet's Mass) I honey, 38, sugar 25, syrup to 100. 

By double decomposition between the Ferrous Sulphate and 
Sodium Carbonate ferrous carbonate is formed, which is incorpo- 
rated with Honey and Sugar to prevent oxidation and to render 
the mixture a plastic mass. The Pill of Ferrous Carbonate (Pil 
Blaudii) is preferable to this mass, as in the pill the ferrous car- 
bonate is better protected against oxidation. 

Massa Hydrargyri ( glycyrrhiza 10, althaea 15, mercury 33. 
(Blue Mass) 1 glycerin 9, honey of rose 33. 

The mercury is extinguished by trituration with the rose honey 
and glycerin and the powdered glycyrrhiza ; the other ingredients 
are then incorporated. The usual dose is from 5 to 10 grains 
(0.3-0.6). 

PILUL/E— PILLS. 

Pills are spherical, more or less soluble masses of medicinal 
substances rendered cohesive, plastic, and firm in consistence by the 
addition of some substance (usually inert) termed an excipient. 

The kind of excipient employed varies with the nature of the 
medicinal substance. As a general rule, such substances are chosen 
as give to the mass, with the smallest proportion, the greatest plas- 
ticity, and also best preserve the spherical shape of the pills. The 
excipient must also, unless the contrary be directed for especial 
purposes, be indifferent in character, to avoid change in the medic- 
inal agents. 

Soluble substances are rendered adhesive by the action of sol- 



SOLID MIXTURES FOR INTERNAL USE. 1 19 

vents, and require, according to their solubilities, the addition of 
some liquid such as Water, Alcohol, Glycerin, etc. Others require 
the addition of adhesive substances, such as Syrup, Mucilage, Glu- 
cose, Glycerite of Starch or Tragacanth, etc. 

Drugs adapted for dispensing in the form of pills may be divided 
as follows : 

(1) The official Masses, Extracts, and Scaled Salts. 

Masses and extracts, being of pilular consistence, require no 
addition except when hard or dry ; Water should then be incor- 
porated to restore them to their original form. Powdered extracts 
are best made into a mass with Water. 

(2) Vegetable Powders in which the dose does not exceed five 
grains. 

With these adhesive excipients are indicated, such as Syrup, Mu- 
cilage, Glycerite of Tragacanth, and Glucose. The last mentioned 
answers the requirements better than most other substances. Con- 
fection of Rose and Extracts of Gentian, Glycyrrhiza, and Taraxa- 
cum are also used when their color is not objectionable. 

(3) Salts not too deliquescent, and Alkaloids. 

Excipients for these must combine adhesive and absorbent quali- 
ties. They are first triturated with a dry powder — e. g. Althaea, 
Glycyrrhiza, or Milk Sugar — and then mixed with the adhesive 
substance — viz. Glucose or Glycerite of Starch or Tragacanth. 

No excipient must be used that will give to the mass a color 
different from that of the medicinal ingredients (the base). 

(4) Volatile Oils and Oleoresins. 

The quantity of these when dispensed in pills being compara- 
tively large, it is necessary to add some light absorbent substance, 
such as Magnesia or Starch, to which is added the adhesive 
material. The practice of adding wax or resin to oils is not to be 
recommended except as a last resort, since they tend to render the 
pill insoluble. 

(5) Resins and Gum Resins. 

These form an adhesive mass by the addition of a little Alcohol, 
with which more bulky excipients, such as Soap, may be incorpo- 
rated to preserve the shape of the pill. 

(6) Salts of the Cinchona Alkaloids, Quinine and Cinchonidine 
Sulphates, etc. 

These are often prescribed in pill form in large doses, and it is 
therefore desirable to reduce their bulk. For this purpose dilute 
Sulphuric Acid or Tartaric Acid is added in small quantity, which 
acts as a solvent upon the salt, thereby converting it into a mass. 



120 



A TEXT-BOOK OF MATERIA MEDICA. 



This mass is incorporated with a little Glycerite of Starch, other- 
wise it soon loses its plasticity; it must therefore be rolled into 
pills as soon as formed. 

(7) Substances easily decomposed by organic matter. 

Potassium Permanganate and Silver Nitrate are quickly " re- 
duced " when incorporated with the excipients usually employed. 

These should be mixed with an inorganic diluent not affected 
by them, such as Kaolin, Pipe Clay, or Fullers' Earth, and made 
into a mass with Water, Petrolatum, etc. 

The following Pills are official : 





Gm. 

for 100. 


IN EACH. 




PlLULiE — 


Gm. 


Grains. 


Excipient. 


Aloes aloes purif., soap, each 


13 


0.13 


2 


Glyc. water. 


Aloes et Ferri . aloes, iron sulph., arom. powder 


7 


O.07 


I 


Conf. rose. 


Aloes et Mastiches (Dinner Pill) . . . aloes 


13 


0.I3 


2 




mastic 


4 


O.04 


f 




red rose 


3 


O.03 


1 


Water. 


Aloes et Myrrhae aloes 


13 


0.13 


2 




myrrh 


6 


O.06 


I 




arom. powder 


4 


O.04 


f 


Syrup. 


Asafoetidae asafcetida 


20 


0.20 


3 


Soap. 


Catharticae Comp. . . ext. coiocynth comp. 


8 


O.08 


4 




mild mercurous chloride 


6 


O.06 






extract of jalap 


3 


O.03 


i 




gamboge 


i-5 


0.015 


1 


Water. 


Catharticae Vegetabiles . ext. coiocynth com. 


6 


O.06 


1 




exts. hyoscyam., jalap, each 


3 


O.03 


I 




ext. leptandra, res. podophyll. 


1-5 


0.015 


J 




oil peppermint 


0.8 


0.008 


I 


Water. 


Ferri Carbonatis ferrous sulphate 


16 


O.06 


1 




(Ferruginous, Chalybeate, Blaud's) 










potass, carb. 


8 








sugar 4 ; tragac, althea, each 


1 






Glyc. water. 


Ferri Iodidi l reduced iron 


4 


O.06 


1 




iodine 


5 








glycyrrh., sugar, each 


4 








ext. glycyrrh., acacia, each 


1 






Water. 


Laxativae Compositae aloin 


i-3 


0.013 


' i 




strychnine 


0.05 


0.0005 


r 


Syrup. 




0.8 


O.008 




ipecac 


0.4 


0.004 


t 




glycyrrhi/a 


4.6 


O.046 




Opii soap 2; opium pulv. 


6-5 


O.065 


1 


Water. 


Phosphori 2 phosphorus 


0.06 


0.0006 


1 




althaea 


6 






Glyc. water. 


acacia 


3 








Podophylli, Relladonnae et Capsici 










resin of podophyllum 


1.6 


O.016 


| 


Acacia and 


extract of belladonna leaves 


0.8 


0.00S 


h 


syrup. 


capsicum 


32 


0.032 


I 




Rhei 'omp rhubarb 


13 


0.13 


2 




aloes 


10 


0.10 


4 




myrrh 


6 


0.06 


1 




oil peppermint 


0-5 






Water. 



' rotation of I ..-.- m ! olu. *' Phosphorus dissolved in Chloroform. 



SOLID MIXTURES FOR INTERNAL USE. 121 

In order to disguise the bitter or otherwise disagreeable taste 
of pills, they are usually coated with sugar or gelatin. These 
coated pills are often objectionable on account of the coating, or 
the pill itself, becoming quite insoluble. When a coated pill is 
desired, it should be freshly made and enclosed in a gelatin capsule 
of the smallest size. Pills may also be coated extemporaneously 
by rolling them on a piece of filter-paper saturated with Mucilage 
of Acacia, and then in powdered Milk Sugar. 

Keratin-coated pills are designed for solution in the duodenum, 
the pills being dipped in a solution of Keratin prepared from horn 
shavings treated with pepsin and hydrochloric acid. Keratin is 
insoluble in the acid gastric juice. 

Concentric pills are made up of concentric layers of different 
ingredients, intended to dissolve and become active at various 
stages in their passage through the intestinal tract. 

Unofficial Pills of the National Formulary. 
When a large number of pills are to be prepared in accordance 
with the given proportions, and the quantities of the ingredients 
are to be determined by multiplying with the number of pills re- 
quired, it is recommended that the nearest whole number, or near- 
est convenient fraction, in each case, be chosen. 

Pilulse— 

Ad Prandium (Dinner Pills). — When " Dinner Pills," under 
this or some other equivalent name, are prescribed without 
further specification, the National Formulary recommends 
that the Pilulae Aloes et Mastiches of the U. S. P., also 
called " Lady Webster's Dinner Pills," be dispensed. 

Of other combinations bearing similar names or used for 
similar purposes, the following appear to be those most 
commonly in use : 

Chapman's Dinner Pill. — Aloes, Mastic, each, grains \\ 
(o.i); Ipecac, grain I (0.06); Oil of Fennel, grain \ (0.015). 

Cole's Dinner Pill. — Aloes, Mass of Mercury, and Jalap, 
each, grains \\ (0.075) 5 Ant. an< ^ Potas. Tartrate, grain -£$ 
(0.0013). 

HaU's Dinner Pill. — Aloes, Ext. of Glycyrrhiza, Soap, 
and Molasses, each, grain 1 (0.06). 
Aloes et Podophylli Composite (Janeway's Pills). — Aloes, 
grain 1 (0.06) ; Resin Podophyllum, grain J (0.03) ; Ext. 
Bellad. Ale, pxt. Nux Vomica, each, grain \ (0.015). 



122 A TEXT-BOOK OF MATERIA MEDICA. 

Pilulae— 

Aloini Composite. — Aloin, grain, J (0.03) ; Resin Podophyl- 
lum, grain J- (0.01); Ext. Belladonna, grain \ (0.015). 

Aloini, Strychnine et Belladonna. — Aloin, grain ^ (0.0 1 
Gm.) ; Strychnine, alkaloid, grain T fa (0.0005 Gm.) ; Alco- 
holic Extract of Belladonna, grain J- (0.008 Gm.). 

Aloini, Strychnine et Belladonna Composite. — Aloin, 
grain I (0.012); Ext. Bellad. Ale, grain J- (0.008 Gm.); 
Strychnine, alkaloid, grain y^-g- (0.0005) '■> Ext. Rham. Pursh., 
grain § (0.03). 

Antidyspeptica. — Strychnine, alkaloid, grain -fa (0.0014); 
Ipecac, Ext. Bellad. Ale, each, grain -fa (0.006) ; Mass of 
Mercury, Ext. Colocynth. Comp., each, grains 2 (0.13). 

Antineuralgice. — I. Gross' Antijieuralgic Pills: Quinine 
Sulphate, grains 2 (0.13); Morphine Sulphate, grain 2V 
(0.003) ; Strychnine, alkaloid, grain fa (0.002) ; Arsenous 
Acid, grain fa (0.003) ; Ex. Aconite Leaves (U. S. P. 1870), 
grain \ (0.03). 

When " Antineuralgic Pills," or " Neuralgia Pills," with- 
out other specifications, are prescribed, it is recommended 
that the above preparation be dispensed. Sometimes the 
Morphine is directed to be omitted. 

2. B r own- Se guard's Antineuralgic (or Neuralgia) Pills: 
Extracts of Hyoscyamus and Conium, each, grain § (0.04) ; 
Extracts of Ignatia and Opium, each, grain \ (0.03) ; Ext. 
Aconite Leaves, grain \ (0.02) ; Ext. Stramonium, grain \ 
(0.01); Ext. Indian Cannabis, grain \ (0.015); Ext. Bellad. 
Ale, grain \ (0.01). 

Antiperiodic/£ (Warburg's Pills). — 1. With Aloes : Aqueous 
Extract of Aloes, grain 1 (0.06) ; Rhubarb, grain \ (0.03) ; 
Elecampane, Saffron, Fennel, each, grain \ (0.015); Zedo- 
ary, Cubebs, Myrrh, White Agaric, Camphor, each, grain \ 
(0.008); Quinine Sulphate, grains if (0.085); Extract of 
Gentian, a sufficient quantity. 

2. Without Aloes : The same formula as above, with omis- 
sion of the Aqueous Extract of Aloes. These pills have 
been introduced for the purpose of facilitating the adminis- 
tration of Warburg's Tincture in a solid form. When 
"Warburg's Pills" or "Pills of Warburg's Tincture " are 
prescribed, without further specification, those containing 
Aloes are recommended to be dispensed — those without 
Aloes only when they are expressly demanded. 



SOLID MIXTURES FOR INTERNAL USE. 123 

Pilulae — 

Each Warburg's Pill represents about 1 fluidram (4 
Cc.) of Warburg's Tincture. (See Tinctura Antiperiodica?) 

Colocynthidis Composite (Pilulse Cochia). — Extract of Colo- 
cynth, grain \ (001); Aloes, Resin of Scammony, of each, 
grains 2 (0.13); Oil of Cloves, min. \ (0.015). 

Colocynthidis et Hyoscyami. — Extract of Colocynth, grain 
■^ (0.006) ; Aloes, Resin of Scammony, Ext. Hyoscyamus, 
each, grains I- 1 (0.1); Oil of Cloves, min. \ (0.0 1). 

Colocynthidis et Podophylli. — Compound Extract of Colo- 
cynth, grains 1^ (0.16); Resin of Podophyllum, grain \ 
(0.015). 

Ferri Composite (U. S. P. 1880). — Myrrh, 1-^ grains (0.1); 
Ferrous Sulphate, Sodium Carbonate, each, \ grains (0.048). 

Galbani Composite (U. S. P. 1880). — Galbanum, Myrrh, 
each, 1^ grains (0.1); Asafcetida, \ grain (0.03). 

Glonoini (Nitroglycerin). — Spirit of Glonoin (1 per cent.), 
Athaea, each, grains 200 (13.0); Confection of Rose, a suf- 
ficient quantity. Make a mass and divide it into two hun- 
dred (200) pills. Each pill contains y^- grain (0.0007) °f 
Glonoin (Nitro-glycerin). 

Laxative Post-partum (Barker's). — Ext. Colocynth. Comp., 
grains if (0.1) ; Aloes, grain f (0.05) ; Res. Podoph., Ipecac, 
each, ^ grain (0.005) \ Ext. Nux Vomica, -f^ grain (0.03) ; 
Ext. Hyoscyamus, \\ grains (0.8). 

This is the formula generally employed by Dr. Fordyce 
Barker, except where special circumstances render modi- 
fications necessary. The formula usually quoted in manu- 
facturers' lists and some formularies is not correct. 

Metallorum (Metallorum Amarae). — Reduced Iron and 
Quinine Sulphate, each, grain 1 (0.06) ; Strychnine and Ar- 
senous Acid, of each, grain -fa (0.003). 

Aitken's Tonic Pill is a similar combination : 

Reduced Iron, grain -| (0.04); Quinine Sulphate, grain I 
(0.06); Strychnine, Arsenous Acid, each, grain -^ (0.0012). 

Opii et Camphors. — Powdered Opium, 1 grain (0.06) ; Cam- 
phor, grains 2 (0.13). 

Opii et Plumbi. — Powdered Opium and Acetate of Lead, 
each, grain 1 (0.06). 

Podophylli, Belladonna et Capsici (Squibb's Podophyllum 
Pills). — Resin Podophyllum, grain J (0.015); Capsicum, 



124 A TEXT-BOOK OF MATERIA MEDIC A. 

Pilulae— 

grain \ (0.03) ; Ext. Bellad. Ale, grain \ (0.008) ; Sugar of 
Milk, grain 1 (0.06) ; Acacia, Glycerin, and Syrup, each, 
a sufficient quantity. 

Quadruplices (Ferri et Quininae Compcsitae). — Ferrous Sul- 
phate, Quinine Sulphate, Aloes, each, grain 1 (0.06) ; Ext. 
Nux Vomica, grain \ (0.015); Ext. Gentian, sufficient. 

Triplices (Triplex). — Aloes, grains 2 (0.13); Resin Podo- 
phyllum, grain \ (0.015); Mass of Mercury, grain 1 (0.06). 
When Pilula Triplex, under this name or some equiva- 
lent, is prescribed without further specification, the N. F. 
recommends that the above preparation be dispensed. A 
formula devised by John W. Francis is also in use : 

2. Francis's Triplex Pill. — Aloes, Scammony, Mass of 
Mercury, of each, grain |- (0.05) ; Croton Oil, -^ min. (0.003) ; 
Oil of Caraway, grain \ (0.015); Tincture of Aloes and 
Myrrh, a sufficient quantity. 

UNOFFICIAL FORMS OF MIXTURES OF SOLIDS FOR INTERNAL 

USE. 

Gra7iules are small pills, less than 1 grain (0.06) in weight, 
usually sugar-coated and containing alkaloids and other active 
drugs. 

Pan'ules are identical with granules. They are usually colored 
red or pink. 

Globules iOrbicuhe) are sugar pellets to be saturated with alco- 
holic solutions of medicinal agents, chiefly in Homoeopathy. 

Compressed Pills or Tablets are made by compressing powders 
into disks not exceeding 10 grains (0.7) in weight, without any ex- 
cipient. 

Friable Pills are made by aggregation, spreading the powdered 
mixture upon nuclei or sugar granules in a revolving pan until the 
pills are formed. 

Bolus is the name given to pills exceeding 5-10 grains (0.3-0.6) 
in weight, used in veterinary practice. A sugar-coated bolus is 
called a Dragee. 

Rotula are disk-shaped forms of sugar about i^- grains (0.1) in 
weight, which may be flavored with alcoholic solution (spirits). 

Bacilli axe. cylindrical sticks, a form of lozenge (Licorice). 

Lamella, thin squares of gelatin in which the active agent has 
been incorporated, intended for solution In the eye. 



PREPARATIONS FOR EXTERNAL USE. 125 

PREPARATIONS FOR EXTERNAL USE. 

To this group belong the liquid preparations : Liniments, 
Oleates and Collodions, and the mixtures of solids : Ointments, 
Cerates, Suppositories, Plasters, and Papers. The Vehicle, some- 
times incorrectly called the " base," consists chiefly of fatty sub- 
stances which serve as protectives or facilitate absorption. The 
Collodions are, however, an exception. 

The solid mixtures may be classified according to their fusi- 
bility, or melting-points, because their therapeutic uses, as well as 
their pharmaceutical forms, are through this quality respectively 
determined. 

Ointments fuse at the body-temperature, and therefore produce 
an emollient effect, or induce absorption of the medicinal substance 
by the system. They are applied by rubbing or inunction. 

Cerates have a higher fusing-point, due to Wax they contain ; 
the medicinal agent is not so readily absorbed, and they are there- 
fore used to produce local effects, being spread on cloth and applied 
as dressings. 

Suppositories tuse siowiy when introduced into a body cavity, 
but maintain their shape at ordinary temperatures. They are for 
use in rectum, urethra, or vagina. 

Plasters have a still higher fusibility ; they do not melt, but 
become adhesive by the body-temperature, and are intended to 
produce local effects and afford mechanical support to the parts 
affected. 

The fusibilities of these various preparations are likewise gov- 
erned by the respective vehicles employed. 

LINIMENTA— LINIMENTS. 

The Liniments are liquid preparations for external use, consist- 
ing of solutions of oily or resi?ious constituents in Alcohol or Oils, 
or mixtures of liquid Soaps. The official Liniments are prepared 
by simple admixture or solution. 

I^inimentum — 

Ammoniae cottonseed oil 57; oleic acid 3; 

ammonia water 35 ; alchohol 5. 
Belladonnse . . camphor 5 Gm. ; fl. ext. belladonna to make 

100 Cc. 

Calcis (Carron Oil) linseed oil 50; lime water 50. 

Camphorae .... cottonseed oil 80 Gm. ; camphor 20 Gm. 
Chloroformi . . . soap liniment 70 Cc; chloroform 30 Cc. 



126 A TEXT-BOOK OF MATERIA MEDICA. 

Linimentum— 

Saponis camphor 4.5 soap 6 ; 

rosemary oil 1 ; alcohol 72.5 ; water to make 100 Cc. 

Saponis Mollis lavender oil 2 ; soft soap 65 Gm. ; 

alcohol to make 100 Cc. 
Terebinthinae . . resin cerate 65 Gm. ; turpentine oil 35 Gm. 

Unofficial Liniments of the National Formulary. 
Linimentum — 

Aconiti et Chloroformi. — Tincture of Aconite, Chloroform, 

each, 2 fluidounces (60 Cc); Soap Liniment, 12 fluidounces 

(355 Cc). 
Ammonii Iodidi. — Iodine, 30 grains (2.) ; Oil of Rosemary, 

Oil of Lavender, each, no minims (7 Cc.) ; Camphor, 220 

grains (15.); Water of Ammonia, if fluidounces (50 Cc); 

Alcohol, enough to make 16 fluidounces (473.17 Cc). On 

standing, it becomes colorless. 
Cantharidis (U. S. P. 1880). — Oil of Turpentine containing 

15 per cent, of Cantharides. 

Iodi (similar to Ph. Br.). — Iodine, 900 grains (60.) ; Potassium 
Iodide, 360 grains (24.); Glycerin, \ fluidounce (15 Cc); 
Water, 1 fluidounce (30 Cc.) ; Alcohol, enough to make 

16 fluidounces (473.17 Cc). 

Opii Compositum (Canada Liniment). — Tincture of Opium, \\ 
fluidounces (45 Cc.) ; Camphor, 120 grains (8.) ; Alcohol, 4 
fluidounces (118 Cc.) ; Oil of Peppermint, 180 minims 
(12 Cc.) ; Water of Ammonia, 6 fluidounces (180 Cc.) ; 
Oil of Turpentine, enough to make 16 fluidounces 
(473.17 Cc). 

Plumbi Subacetatis (U. S. P. 1880). — Solution of Lead Sub- 
acetate, 35 parts ; Cotton Seed Oil, 65 parts. 

Saponato-camphoratum (Opodeldoc ; Solid Opodeldoc). — 
White Castile Soap, \\ ounces (45.); Camphor, \ ounce 
(15.); Alcohol, 20 fluidounces (592 Cc.) ; Oil of Thyme, 30 
minims (2 Cc.) ; Oil of Rosemary, 60 minims (4 Cc.) ; Water 
of Ammonia, Fort., 1 fluidounce (30 Cc). 

TEREBINTHINAE Aceticum (Linimentum Album., Stokes' Lini- 
ment ; St. John Long's Liniment). — Oil of Turpentine, 3 
fluidounces (89 Cc) ; Fresh Egg, 1; Oil of Lemon, 60 
minims (4 Cc) ; Acetic Acid, 300 minims (20 Cc) ; Rose 
Water, l\ fluidounces (75 Cc). 

Tigli] (Linimentum Crotonis, Ph. Br.). — Croton Oil, 2 fluid- 
drams (8 Cc); Oil of Cajuput, 7 fluidrams (27.5 Cc). 



PREPARATIONS FOR EXTERNAL USE. 127 

Mistura — 

Tiglii Compositum. — Croton Oil, 1 fluidounce (30 Cc); Oil 
of Sassafras, 1 fluidounce (30 Cc.) ; Oil of Turpentine, I 
fluidounce (30 Cc.) ; Oil of Olive, 2 fluidounces (60 Cc). 



LOTIONES— WASHES. 
Lotio — 

Adstringens (Warren's Styptic). — A mixture of Sulphuric 

Acid, Oil of Turpentine, and Alcohol. 
Flava (Yellow Wash, Aqua Phagedaenica Flava, Ph. Ger.). 
— Corrosive Mercuric Chloride, 24 grains (1.5), in Lime 
Water, 16 fluidounces (473 Cc). 
Nigra (Black Wash ; Aqua Phagedaenica Nigra, Ph. Ger.). 
— Mild Mercurous Chloride, 64 grains (4.), in Lime Water, 
16 fluidounces (473 Cc). 
Plumbi et Opii (Lead-and-Opium Wash). — Lead Acetate, 
120 grains (8.); Tincture of Opium, J fluidounce (15 Cc); 
in Water, 16 fluidounces (473 Cc). To be shaken when 
dispensed. 
The following are unofficial solutions and mixtures for external 
use: 

Injectio, -ones. — Aqueous solutions for introduction by means 

of a syringe in the orifices of the body. 
Injectio Hypodermica. — Solution for hypodermic or subcu- 
taneous injection. 
Enema, -atis ; Clyster. — A warm solution of Soap or a muci- 
laginous mixture for injection in the rectum to produce 
evacuation, or for nutrition. 
Gargarisma, -atis ; Gargle. — A wash or lotion for the throat. 
Collyrium, -i ; "Eye-wash." — A weak solution for instillation 

in the eyes. 
Nebula, -ce ; Spray. — A liquid intended for application by 

means of an atomizer. 
Vapor, -oris ; Inhalation. — Volatile agents to be added to 

boiling water and inhaled, to affect the air-passages. 
Balneum, -ei ; Bath. — Mixture to be added to water for bath- 
ing purposes. 

OLEATA— OLEATES. 

The official Oleates are solutions of oleates in Oleic Acid. 
They are distinct from the solid oleates, which are made by double 
decomposition of salts of the metals and alkaline earths and 
sodium oleate, or Soap. (See Soap) 



128 A TEXT-BOOK OF MATERIA MEDICA. 

The liquid or official Oleates are intended for endermic medica- 
tion. They are applied by inunction, when the Oleic Acid favors 
the absorption of the medicinal agent, the oleate in solution. When 
it is not desirable to administer remedies by the mouth, the Oleates 
afford an effective form of medication. 

The solid Oleates are either dry powders, well adapted for pro- 
tectives as dusting powders, or soft, pliable masses to be applied in 
the form of ointments or plasters. 

Oleatum — 

Percentage 
by Weight. 

Atropine atropine 2 

Cocaine cocaine 5 

Hydrargyri yellow mercuric oxide 2.5 

Quinine . . quinine 2.5 

Veratrin^e veratrine 2 

Unofficial Oleates of the National Formulary. 

The following are simply solutions of the alkaloids in Oleic 
Acid: 



Aconitin^e. — Contains 2 per cent, of crystallized Aconitine 

(Duquesnel's). 
Quinine.— Contains 25 per cent, of Quinine (Alkaloid). 

Of the solid Oleates introduced by Dr. J. V. Shoemaker, the 
following have been recognized, but others may also be prepared 
as desired : 

Oleatum Plumbi. — Contains about 28 per cent, of Lead Oxide. 

It is of the consistence and general character of Lead Plaster, 

and suggests similar use. 
Oleatum Zinci. — In the form of a soft white powder, useful as 

a "dusting powder," or converted into a plaster or ointment 

by mixing it with such proportion of Oleic Acid as may be 

required. 

OLEA INFUSA— INFUSED OILS. 
These preparations are obtained by infusing a dry herb, usually 
from the SO-called narcotic plants, in five times its weight of a 
mixture of equal parts of Cotton Seed Oil and Lard Oil. Oleum 



PREPARATIONS FOR EXTERNAL USE. 129 

Hyoscyami Infusum is the most familiar example. There are none 
official. 

Oleum — 

Carbolatum. — A mixture of Cotton Seed Oil with $ per cent, 
of Carbolic Acid. 

Hyoscyami Compositum (Balsamum Tranquillans). — Infused 
Oil of Hyoscyamus, with a small proportion of each of the 
Ethereal Oils of Absinth, Lavender, Rose, Sage, and Thyme. 

COLLODIA— COLLODIONS. 

The Collodions are solutions in Ether-Alcohol of Pyroxylin or 
Soluble Gun Cotton. Upon evaporation of the solvent the remain- 
ing film excludes the air, thus protecting abraded surfaces. Col- 
lodion is also used as a vehicle when a prolonged local effect is 
desired. 

The following forms are official : Per cent 

Collodium . . solution in ether 75 ; alco. 25 ; pyroxylin 4 

Collodium Flexile . . . castor oil 3 ; Canada turpentine 5 

Collodium Stypticum .... alco. 5 ; ether 25 ; acid tan. 20 
Collodium Cantharidatum (Blistering Collodion) . (flex. 

collo.) cantharides 60 

Unofficial Collodions. 
Collodium — 

Iodatum (Iodized Collodion). — Contains 5 per cent. Iodine in 

Flexible Collodion. 
Iodoformatum (Iodoform Collodion). — Contains 5 per cent. 

Iodoform in Flexible Collodion. 
Salicylatum Compositum (Corn Collodion). — Contains 1 1 per 

cent. Salicylic Acid and 2 per cent. Ext. Cannabis Indica in 

Flexible Collodion. 
Tiglii (Croton Oil Collodion). — Contains 10 per cent. Croton 

Oil in Flexible Collodion. 

UNGUENTA— OINTMENTS. 

Ointments are mixtures of a fatty vehicle with which medicinal 
agents are incorporated, readily fusing at the body-temperature, 
35°to40° C. (95 to 104 F.). 

The medicinal ingredients must be minutely distributed through 
the vehicle in order that the ointment may not prove irritating, and 
that the greatest possible surface be presented to the epidermis 



130 A TEXT-BOOK OF MATERIA MEDICA. 

with a view to quick and uniform absorption. For this reason the 
highest quality of an ointment (next to its proper melting-point) is 
smoothness. In the preparation of ointments care must therefore 
be taken that the method employed be such as to yield smooth 
products. 

The melting-point is governed by the fusibility of the vehicle 
used, which is either officially directed, as in official preparations, 
or in extemporaneous preparations prescribed by the physician. 

The official Ointments are prepared (1) by mechanical admixture, 
(2) by fusion, or (3) by chemical reaction. 

Mixing the medicinal substances with the fatty body in a mor- 
tar or on a slab is the process usually employed for solid sub- 
stances, especially when insoluble in the fat. Powdered drugs, 
acids, alkaloids, extracts, and salts (not attended by chemical 
union) are examples adapted to this process. 

The following points must be observed : 

Solids must be in a fine powder before being incorporated with 
the vehicle ; sometimes it is an advantage to triturate the solid with 
a small quantity of a bland fixed oil, as Almond Oil or Olive Oil, 
into a smooth cream before it is mixed with the vehicle proper — 
Lard, etc. 

Extracts should be reduced to a semi-liquid condition by tritura- 
tion with a little dilute Alcohol or Water. Substances soluble in 
fats, such as Carbolic Acid, Iodine, and Camphor, may be dis- 
solved directly in the fat by the aid of a gentle heat. 

The following are the official Ointments, with their drug- 
strengths, their respective vehicles being given in parentheses : 

Percentage 
Unguentum — of Drugs. 

Acidi Borici (paraffin and white petrolatum) 10 

Acidi Tannici (glycerin and oint.) 20 

Aquaj Rosa: (Cold Cream) . . spermaceti 12.5 ; white 

wax 12; expressed oil of almond 56 

then incorporate borax 0.5 ; rose water 19 
Belladonna,- extract .... (dil. alcohol 5 ; benz. lard 

and hydrous wool-fat) 10 

Chrysarobini (chrysophanic acid) .... (benz. lard) 6 

Diachylon (Hebra's) lead plaster 50 

oil lavender 1 ; olive oil 49 

Gallae (ointment) 20 

Hydrargyri (Mercurial Ointment) mercury 50 

mercuric oleutc 2 ; suet 23 ; benz. lard 25 



PREPARATIONS FOR EXTERNAL USE. 131 

Unguentum — 

Hydrargyri Ammoniati . . . (white petrolatum and 

hydrous wool-fat) 10 

Hydrargyri Dilutum (Blue Ointment) . mercurial oint. 67 

petrolatum 33 

Hydrargyri Nitratis (Citrine Ointment) . . . mercury 7 

nitric acid 17.5 ; lard 76 
Hydrargyri Oxidi Flavi . . . (hydrous wool-fat and 

petrolatum) 10 
Hydrargyri Oxidi Rubri . . . (hydrous wool-fat and 

petrolatum) 10 

Iodi (potass, iod. 4, glycerin benz. lard) .... iodine 4 

Iodoformi (lard) 10 

Phenolis (white petrolatum) 3 

Picis Liquidae yellow wax 15 ; lard 35 ; tar 50 

Potassii Iodidi . (pot. carb. 0.6 ; water 10 ; benz. lard) 10 
Stramonii Extract . . . (dil. ale. 5 ; hydrous wool-fat 

and benz. lard) 10 

Sulphuris (washed) (benz. lard) 15 

Veratrinae (almond oil 6) . . (benz. lard) 4 

Zinci Oxidi (benz. lard) 20 

Zinci Stearatis (white petrolatum) 50 

Unofficial Ointments of the National Formulary. 

Unguentum Acidi Gallici (U. S. P. 1880). — Contains 10 per 
cent. Gallic Acid. 

Unguentum Calamine (Unguentum Zinci Carbonatis Im- 
puri; Turner's Cerate). — Contains 17 per cent. Zinc Car- 
bonate (Imp.). 

Unguentum Camphors (Unguentum Camphoratum). — Con- 
tains 20 per cent. Camphor. 

Unguentum Fuscum (Unguentum Matris ; Mother's Salve). 
— Contains 50 per cent, of Camphorated Brown Plaster 
(N.F.). 

Unguentum Mezerii (U. S. P. 1880). — Represents 25 per 
cent. Mezereum. 

Unguentum Picis Compositum (Tar, Comp.). — Contains Oil 
of Tar, 4 per cent. ; Tincture of Benzoin, 2 per cent. ; and 
Oxide of Zinc, 3 per cent. 

Unguentum Sulphuris Alkalinum (U. S. P. 1880). — Contains 
20 per cent. Sulphur and 10 per cent. Potassium Carbonate. 



132 A TEXT-BOOK OF MATERIA MEDICA. 

Unguentum Sulphuris Compositum (Wilkinson's Ointment ; 
Hebra's Itch Ointment). — Precipitated Calcium Carbonate, 
10; Sublimed Sulphur, Oil of Cade, of each, 15; Soft 
Soap and Lard, of each, 30 parts. The Lard is mixed 
with the Soft Soap and Oil of Cade; the Sublimated 
Sulphur and Precipitated Calcium Carbonate are then grad- 
ually incorporated. 

CERAT A— CERATES. 

Cerates are mixtures of fats similar to the ointments, but of 
firmer consistence, because they contain Wax, Resin, or Paraffin 
(having a higher melting-point than Lard) in greater proportion 
than do ointments. In the preparation of Cerates the -same rules 
are to be observed as noted under Ointments. 

The six official Cerates are prepared by fusion or simple admix- 
ture, and one by extraction and digestion (Ceratum Cantharidis) : 

Percentage 
of Drugs. 

Ceratum (Simple) . . . white petrolatum 20 ; benz. lard 50 

white wax 30 

Camphorae . camphor liniment 10; white petrolatum 15 

benz. lard 40; white wax 35 

Cantharidis (Blistering Cerate), liquid petrolat 15 ; lard 17 

cantharides 32 

yellow wax, resin, each 18 

Plumbi Subacetatis (Goulard's Cerate) . . . camphor 2 

solution lead subacetate 20 
wool-fat ; paraffin ; white petrolat. 

Resinae (Basilicon) . . yellow wax 15; lard 50; rosin 35 
in cold weather yellow wax 1 2 ; 

lard 53; resin 35 
Resinae Compositum . rosin 22.5 ; yellow wax 22.5 ; 

suet 30; turpentine 1 1.5; linseed oil 13.5 

Ceratum Camphor/k Compositum, N. F. (Camphor Ice). — 
Moulded into small cakes suitable for popular use as an applica- 
tion to excoriated surfaces. It contains very small quantities of 
Benzoic and Carbolic Acids. 



PREPARATIONS FOR EXTERNAL USE. 133 

SUPPOSITORIA— SUPPOSITORIES. 

Suppositories may be defined as variously shaped masses of 
medicated fat, possessing a consistence ensuring their quick fusion 
when introduced in the orifices of the body. 

The U. S. P. defines Suppositories with reference to their 
weights and shapes, corresponding to their several uses — i. e. for 
introduction in the respective orifices of the body— as follows : 

Rectal, cone-shaped or spindle-shaped, should weigh 30 grains 
(2 Gm.). 

Urethral, pencil-shaped, should weigh 30 to 60 grains (2-4 Gm.). 

Vaginal, globular or oviform, should weigh about 60 grains 
(4 Gm.). 

The vehicle is Cacao Butter {Oleum Theobromatis) or Glycerin- 
ated Gelatin, both of which possess the property of melting at the 
temperature of the human body, 35 C.(95° F.), and yet remaining 
firm at ordinary temperatures. An addition of 10 to 15 per cent, 
of spermaceti is recommended to raise the melting-point and thus 
give more stability to suppositories during the heated seasons of 
the year, or if they contain chloral, phenol, or other substances 
which soften the vehicle. 

The U. S. P. gives a general formula for preparing supposi- 
tories ; only one Suppository is official, and this is not made from 
Cacao Butter. 

The methods of preparing suppositories are quite numerous : 
any process may be employed by which the product is obtained 
uniform in size and shape and with the medicinal ingredients thor- 
oughly incorporated. Moulds are usually employed ; the medici- 
nal ingredients, if solid, are first reduced to powder in a mortar, 
and mixed with a small quantity of the grated Fat ; the remainder 
of the Fat, previously melted and cooled to 35 ° C, is then gradually 
incorporated with this mixture, thoroughly mixed, and, if possible, 
without further heating, poured into the moulds, previously chilled. 

Another process consists in rolling the mass on a slab, cutting 
it as in making pills, and forming the cones with the fingers. By 
cold compression in a screw-press " machine," suppositories may 
be formed from the prepared mass. 

Urethral Suppositories are commonly called Bougies, or, more 
properly, Medicated Bougies. They are usually made with the 
addition of Wax, or from Glyco-gelatin mass. 

Suppositoria Glycerini. — Glycerin 30 ; sodium carbonate 0.5 ; 



134 A TEXT-BOOK OF MATERIA MEDICA. 

stearic acid 2 ; water 5. They are made by heating until a solution 
of sodium stearate, or soap, is formed, which is poured into a mould. 
Upon cooling, the mixture gelatinizes and the suppository is 
wrapped in tin-foil. 

Uses. — Upon introduction into the rectum the mass melts, and 
the Glycerin, acting upon the feces, produces evacuation. 

A formula for suppositories would be : 

Extracti Belladonnas Fol., ale, 0.1 ; 
Acidi Tannici, i.O; 

Olei Theobromatis, q. s. (20 Gm.). 
Fiant suppositoriae No. x. (2 Gm.). 

Each suppository would contain \ grain (0.0 1 ) Ext. Belladonna 
and 1^ grains (0.1) Tannic Acid. 

EMPLASTRA— PLASTERS. 

Plasters are mixtures of various fatty or resinous solids of such 
high melting-point as to be friable when cold, but rendered adhesive 
by the warmth of the body. 

The vehicles of plasters are : Lead plaster ; resinous substances, 
made adhesive by admixture with the medicinal ingredients ; and 
simple plasters, such as isinglass. 

The making of plasters does not differ materially from the pro- 
cess employed for ointments and cerates, since they are all prepared 
by melting the various substances and incorporating the medicinal 
substances last. The spreading of plasters, though usually done 
on a large scale, may be easily effected by the pharmacist with the 
use of a plaster iron. 

The official Plasters may be divided into: (1) Lead Plasters; 
(2) Pitch and Gum-Resin Plasters ; and (3) Isinglass Plasters. 

(1) The most important plasters are made from Lead Plaster, 
or Lead Plaster mixed with Resin, the official Resin Plaster. 

Percentage or 
Emplastrum — parts in 100. 

Adhaesivum . . rubber 2 ; petrolatum 2 ; lead plaster 96 

Plumbi (Diachylon) . . . soap 100; lead acetate 60 ; 

water q. s. 

From these the following arc prepared; 



PREPARATIONS FOR EXTERNAL USE. 135 

Emplastrum — 

Belladonnae ext. belladonna leaves 30 

adhesive plaster 70 

Capsici adhesive plaster, 15x15 cm. ; 

oleoresin capsicum 0.25 
Hydrargyri . . hydrous wool-fat 10 ; lead plaster 59 ; 

mercury oleate I ; mercury 30 

Opii .... adhesive plaster 90 ; water; ext. opium 6 

Saponis lead plaster 90; soap 10 

Unofficial Plasters of the National Formulary. 
Emplastrum — 

Ammoniaci (U. S. P. 1880). — Gum-resin Ammoniac with 
Acetic Acid. 

Aromaticum (Spice Plaster). — Consisting of Cloves, Cinna- 
mon, and Ginger, each, 10 per cent. ; Capsicum and Cam- 
phor, each, 5 per cent. 

Asafoetim: (U. S. P. 1880). — Asafcetida 35 p.; Galbanum 15 
p. ; with Lead Plaster. 

Fuscum Camphoratum (Matris Camphoratum, Ph. Ger.). — 
Camphorated Mother's Plaster. A plaster similar to lead 
plaster, and containing camphor, 1 per cent. 

Galbani (U. S. P. 1880). — Galbanum Plaster. 

Picis Canadensis (U. S. P. 1880). — Canada Pitch Plaster. 

Picis Liquids Comp. — A mixture of Resin and Tar, with Podo- 
phyllum, Phytolacca, and Sanguinaria, of each, 10 per cent. 

CHARTS— PAPERS. 

There is one Paper official. It is paper coated with Mustard, 
used similarly to the Plasters : 

Charta Sinapis . . oil-free black mustard, 4 Gm. in 60 sq. cm. 

The Mustard is freed from the fixed oil by extraction with Ben- 
zin, and mixed with a solution of India Rubber in equal volumes 
of Benzin and Carbon Disulphide, and spread upon Paper. This 
is the well-known Mustard Plaster or Mustard Paper. When 
applied, the paper should be immersed in lukewarm water for a 
few minutes, in order to render the vesicating principle active. 

Charta Cantharidis, U. S. P. 1880. — Cantharidis Paper (Blis- 
tering Paper). 



136 A TEXT-BOOK OF MATERIA MEDICA. 

Poultice or Cataplasm (Lat. Cataplasma, -atis). — A coarsely 
ground substance or mixture of substances, such as flaxseed or 
elm-bark, made into a mass with hot water or some other liquid, 
spread upon cloth or filled into porous bags, and applied to the 
body while hot. 

Fomentations (Lat. Fomentum, -1). — Porous woollen cloths sat- 
urated with hot infusion or decoction of herbs, or other hot liquids 
or lotions, and applied hot. 

Spongiopiline. — A thick cloth covered with layers of sponge 
for the saturation and retention of medicinal agents intended for 
absorption, the exterior being composed of waterproof material, 
such as rubber. 

Plaster-Mull. — A thin cloth made impervious with rubber or 
gutta-percha tissue, upon which is spread or painted medicinal 
agents in the liquid form, intended for local application. 

Caustics or Escharotics (Gr. Escharotikos). — Substances used 
to destroy tissue by chemical action or by heat, either semi- 
solid mixtures made into a paste with starch or other diluent, or 
chemicals fused and moulded into sticks called pencils or " crayons " 
(Lat. stilus, -i), to be applied directly to the skin. Moxa is the 
name given to small cones of combustible substances which upon 
incineration do not inflame, but give off an intense heat, used for 
cauterization when heat is desired. 

Bandages ; Antiseptic Dressings. — The material used for 
bandages is cellulose in various modifications, such as cotton, 
linen, jute, and other fibrous substances. Aside from the me- 
chanical support afforded, bandages also serve to keep wounds 
clean by absorbing and withdrawing secretions (pus) which would 
otherwise prove irritating, and by protecting them against extrane- 
ous matter serve to promote the healing process. 

These various substances may be used either plain or medi- 
cated, when they are called antiseptic. 

Gossypium Punficatum, 17. S. P.; Absorbent Cotton. — The hairs 
of the seed of Gossypium hcrbaccuin L., freed from oil and resinous 
substances by treatment with alkalies and bleaching agents. These 
hairs represent microscopic ducts in which liquids are absorbed 
through capillarity. The freer from oily constituents, the more 
readily will watery liquids be taken up and retained ; hence, the 
absorbability of cotton depends upon its purity. This is equally 
true with all other bandage material. 

Linen in the form of thin sheets, known as Muslin or Muslin- 



PREPARATIONS FOR EXTERNAL USE. 1 37 

gauze, or purified similarly to cotton, when it is called Lint, is 
made from the bast-fibres of the Linum usitatissitnum L., Flax. 
Hemp and Jute are the bast-fibres of their respective plants. 

Medicated Dressings. — These are made by saturating the ma- 
terial or vehicle in a solution of certain strength of the medicinal 
agent, or incorporating the latter in powdered form. In the appli- 
cation of a dressing which has been rendered aseptic or antiseptic 
by impregnating it with Phenol (Carbolic Acid), Salicylic Acid, 
Mercuric Chloride, or similar agent, it is desired to bring in con- 
tact with the wound a solution of certain strength — for example, 
a 5 or 10 per cent, solution of Phenol, a -^ or -^ of I per cent, 
solution of Mercuric Chloride, etc. The quantity of material which 
conveys the agent is of no consequence, as the fabric simply serves 
as a vehicle for the medicinal or antiseptic agent. The strengths 
of such dressings should therefore be designated by the percentage- 
strength of the solutions by which they are saturated, rather than by 
the percentage by weight of the medicinal agent the finished dress- 
ing may contain. 

In dressings of antiseptic agents that are usually applied in sub- 
stance, such as Boric Acid and Iodoform, the percentage-amount 
actually contained by weight in the finished dressing should be 
stated. Here the use of a vehicle is only a matter of convenience, 
and it is desirable to know just how much of the medicinal agent 
is contained in a certain quantity by weight or by area of the 
dressing. 

Medicated Cottons. — Purified cotton is saturated in a solution 
in Water, or Glycerin and Water, of the strength desired of the 
medicinal agent, and thoroughly expressed. 

The following are the usual strengths : 

Percentage. 

Gossypium Boratum acid boric 5 or 10 

Carbolatum phenol 5 or 10 

Iodoformatum iodoform 10 to 20 

Salicy latum acid salicylic 10 to 20 

Stypticum MonsePs solution 

Sublimatum mercuric chloride y 1 -^ to -fa 

Iodoform, being insoluble in Water, should be dissolved in Ether 
or, preferably, in a mixture of Alcohol and Glycerin. 

Medicated Gauzes ; Carbasa. — The material used for making 
Medicated Gauzes is a muslin gauze free from sizing or other ex- 
traneous matter. The gauze is thoroughly impregnated with the 



138 A TEXT-BOOK OF MATERIA MEDICA. 

solution of the particular strength required, then forcibly expressed, 
after which it is ready for use ; or, if desired for future use, it should 
be tightly rolled, wrapped in parchment paper, and kept in closely 
covered boxes in a cool, dry place. 

The following are the most commonly used Gauzes and their 
strengths : 

Percentage. 

Carbasus Boratum acid boric 5-10 

Carbolatum phenol 5-10 

Iodoformatum iodoform 10-20 

Salicylatum acid salicylic 10-20 

Sublimatum mercuric chloride ^ ^ 

The Iodoform Gauze is made in the same way as the Cotton, 
by saturation with a solution of Iodoform in Alcohol and Glycerin. 
All the others, except the Mercurial Gauze, contain Glycerin. 
Mercuric Chloride is dissolved in Water with a little Acid Tartaric 
(5 parts for 1 of Mercuric Chloride), the presence of which in the 
Gauze prevents the formation of insoluble albuminate of mercury 
when it is brought in contact with the albuminous discharges from 
wounds. 

Plaster-of-Paris bandages are made by thoroughly incorpo- 
rating Calcium Sulphate (gypsum) into linen bandages. When 
applied, the bandage, after being dipped in water, sets hard and 
firm in a few minutes. 



DRUGS WHOSE CHIEF ACTION IS ON THE 
NERVOUS SYSTEM. 



THE ALCOHOLS. 

A large number of compounds which are derived from mem- 
bers of the marsh-gas series are employed in medicine as depres- 
sants of the nervous system, acting more particularly on the higher 
cortical structures. They are here considered in one general group 
because of their close similarity in pharmacological action and 
in therapeutic efficiency. While the fundamental action of these 
derivatives is on nervous structures, it not infrequently happens that 
other effects — such as the action of alcohol on the heart, of chloral 
on muscular tissues, etc. — are of great therapeutic service. Such a 
consideration brings again into prominence the difficulties of thera- 
peutic classification. 

The bodies here under discussion are very numerous. They 
are derived from various members of the series, and include hydro- 
carbons, alcohols, ethers, aldehydes, ketones, esters, acids, halogen 
substitution compounds and their derivatives. 

The simplest members of the paraffine group of this series are pentane, C 5 H 12 , 
hexane, C 6 H U , both of which are distilled from petroleum, coming off between 
6o°-8o° C, (i40°-i76° F. ). Their mixture constitutes the well-known petroleum 
ether, or naptha, used so extensively in some anesthetic mixtures ; gasolin, or 
benzin, coming off at higher temperature, 8o°-i20° C. ( i76°-28o° F.), containing hep- 
tanes, C 7 H 16 ; octanes, C 8 H 18 , has also been used as a general anesthetic. 

Of the olefines, or unsaturated hydrocarbons, amylene, C 5 H 10 , 
and acetylene, C 2 H 2 , have been used as general anesthetics. They 
have not proved satisfactory. 

The hydroxyl compounds of the saturated hydrocarbons, the 
alcohols, constitute highly important members of the group. The 
simplest methyl alcohol, CH 3 OH, is widely used in the arts as 
a solvent, and is frequently drunk as an intoxicant — often with dis- 
astrous effects, as will be pointed out ; ethyl alcohol, C 2 H 5 OH, 
the next member of the group, is one of the most ancient of reme- 
dies and perhaps the most widely used known drug. Its importance 
in dietetics, in therapeutics, and in toxicology is far-reaching. The 
higher alcohols, propyl, C,H 7 OH, butyl, C 4 H 9 OH, and amyl, C 5 H n - 
OH, are frequently found in ordinary alcoholic drinks, and, as fusel 
oil, constitute important poisonous principles. 

Amylene hydrate, dimethyl ethyl carbinol, (CH 3 ) 2 (C 2 H 5 )COH, 
is a hypnotic of this same series. 

The oxides of the hydrocarbons, ethers, are represented chiefly by 

139 



140 A TEXT-BOOK OF MATERIA MEDICA. 

ether, diethyl oxide, (C 2 H 5 ) 2 0, the most widely employed general 
anesthetic. The aether of the Pharmacopoeia contains a small per- 
centage of alcohol, but a new synthetic ether has been introduced 
commercially and is under investigation. Methylal, methylene 
dimethyl ether, CH 3 OCH 2 OCH 3 , and acetal, diethyl acetal, 
C,H 5 OCHCH 3 OC 2 H 5 , have also been introduced, as anesthetic and 
hypnotic respectively. A few compound ethers, esters, compounds 
of an alcohol (or phenol) with an acid are of importance. Most of 
these bodies by the interposition of the acid molecule are weaker than 
the ethers of analogous structure. The action of many is unknown. 
Thus methyl formate (CH 3 OCOH) is a constant constituent in 
crude wood-alcohol and may be one of the factors in its toxic action. 
Ethyl formate (C 2 H 5 OCOH) is extensively used in the manufac- 
ture of artificial rum and arrack. Amyl acetate (QH n OCOCH 3 ) 
and the allied ethyl butyrate and iso-amyl iso-valerate are widely 
employed as artificial flavors, pears, pineapple and apples, respec- 
tively. Most of the fruit essences are mixtures of these and allied 
esters. 

The addition of alcohol to the nitrous acid radical forms the 
ester, amyl nitrite (QH u ONO), so widely employed as a vaso- 
dilator. In this preparation, however, the NO ions play an im- 
portant part. The esters formed with carbamic acid, urethane, 
ethyl carbamic ether, (C 2 H 5 )CO(NH 2 ), ((OC 9 H 5 )CO(NH 9 )), and 
hedonal ((C 2 H 5 )CO(NH 2 )), ((OC 2 H 5 )CO(NH 2 )), a similar ester with 
amyl alcohol, have wide applicability as reliable hypnotics. Vero- 
nal, diethyl malonyl urea, (C(C 2 H 5 ) 2 CO(CONH 2 ) 2 ), is a recent 
valuable addition to this series. 

A number of important aldehydes are used : Paraldehyde 
(C 2 H 4 0) 3 is one of the oldest, while within comparatively recent 
years several sulphur aldehydes have been introduced ; sulphonal 
(CH 3 ) 2 C(S0 2 ) 2 (C 2 H 5 ) 2 , trional (CH 3 )(C 2 H 5 )C(S0 2 ) 2 (C 2 H 5 ) 2 , and 
TETRONAL (C 2 H 5 ) 2 C(S0 2 ) 2 (C 2 H 5 ) 2 are the most important of these. 
Sulphonal is the mildest, trional stronger; tetronal is considered 
almost dangerous. 

A number of halogen derivatives have been formed and are 
valuable. The addition of chlorine, bromine, or iodine to the 
hydrocarbons have resulted in chloroform, CHC1 3 , bromoform, 
CI [Br s , and iodoform, CHI 3 , the first in wide use as an anesthetic; 
bromoform as an antispasmodic (still under trial), and iodoform, a 
valuable antiseptic, showing its alcoholic relationships only in certain 
forms of poisoning. In these halogen compounds the CI, Br, and I 
ions modify or entirely change the action of the hydrocarbon 
nucleus. In the case of all of the chlorine synthetics a certain pois- 
oning of the heart muscle seems to accompany the combination. 
Ethyl compounds are ethyl chloride, C 2 H 6 C1, a useful general, as 
well as local, anesthetic, and the closely related ethylene and e thy lidine 
pounds (CI LCI — CJLC1) and (CH 8 CHC1 2 ), symmetrical and 
unsymmetrical ethane derivatives, are unsafe. Methylene chloride, 
CH 2 Clj has also been used as a general anesthetic. Aldehyde 



THE ALCOHOLS. 141 

combinations with chlorine are : chloral, CCl 3 COH, trichloralde- 
hyde, or more properly chloral hydrate (chloral + water) ; butyl 
or croton chloral (trichlor butyl-aldehyde -f water), ((C 3 H 4 C1 3 )- 
CO + H 2 0); chloralose (chloral + glucose) ; chloretone (chloral 
-f acetone) (CCl 3 (CH 3 ) 2 OH) ; chloralamide (chloral formamide), 
(CCl 3 CHOHCONH 2 ); ural, (CCl 3 COH) + (00 2 H 5 )CO(NH 2 ), a 
combination of chloral and urethane ; somnal, ural in which another 
ethyl replaces the OH in chloral. This by no means exhausts the 
list of these alcohols and their derivatives. Synthetic chemists con- 
tinue their kaleidoscopic manipulations, and undoubtedly many 
more useful members of this class will be introduced. The great 
necessity in the chloral series has been to devise combinations that 
would have a more agreeable taste than chloral, and further, com- 
pounds that would not possess cardiac-depressing effects. For the 
greater part it would seem that only with the weakest of these had 
this been accomplished. Efforts have further been directed to the 
obtaining of a chloral derivative in combination with an analgesic. 
Hypnal, a combination of chloral and antipyrine, was such, but it 
does not seem to have met with favor. 

The physiological action of all of the compounds shows a marked 
qualitative resemblance. With the advance in the series, from lower 
to higher, until insolubility or non-absorbability militate, they show 
an increasing quantitative reaction, and from the chemical composi- 
tion alone a fairly accurate estimate may be made of the grade of 
this increase in the physiological action. Naturally with the intro- 
duction of other active radicals, both qualitative and quantitative 
variations are introduced. 

It has been thought that the action of this group of bodies 
depends in large part on their special affinity for certain classes of 
compounds as found in both plants and animals. Disregarding the 
evidences derived from anesthetization of the leaves of the sensitive 
Mimosce, etc., the studies of Meyer and Overton seem to represent 
the best interpretations of the cause of action of these bodies. They 
have elaborated and confirmed in great detail the belief that it is 
because of the affinity that these bodies have for lipoids, or fatty 
substances, that their physiological activities are what they are, 
and because of the great abundance of these lipoid substances, 
cholesterin, lecithin, etc., in the nervous structures, there is, as it 
were, a localized action in these organs, and in a few others rich in 
fat, the liver (cirrhosis) etc. The ganglion cells of the central 
nervous system are particularly rich in lipoid substances, and hence 
their great affinity for this group of substances. The further 
evidence of Mann, Vas, Nissl, and others seems to lend some histo- 
logical foundation to the hypothesis. 

It is upon the nervous structures, then, that these bodies act, and 
the effect is one of gradual poisoning. As may be pointed out later, 
certain clinical symptoms accompanying the use of members of this 
series may seem to show irritation and exaltation of function, but 
even these signs of stimulation are capable of being interpreted in 



142 A TEXT-BOOK OF MA TERIA MEDICA. 

line with the general hypothesis of primary and persistent nerve- 
cell depression. 

The grade of activity of these substances would seem to depend 
upon the relationship of the affinity of these bodies for water and 
for oily substances, and physicochemical methods have introduced 
a series of criteria by which their toxicity, for lower animals at least, 
might be measured. Thus methyl alcohol is freely soluble in water 
and dissolves in oil (olive oil being the oil usually used) with great 
difficulty. Hence its ability freely to enter into the protoplasm is 
limited, and its toxic action may be inferred to be slight. Amyl 
alcohol is less freely soluble in water and readily soluble in oils, its 
coefficient is higher and its toxic power much greater. 

Overton has constructed a table showing the results of a series 
of experiments on plants and lower animals relative to this point. 

Alcohol— Alcoholis— Alcohol. TJ. S. I*. 

Definition. — A liquid composed of about 92.3 per cent, by weight, or 94.9 per 
cent, by volume, of absolute ethyl alcohol, and about 7.7 per cent, by weight of water. 

Description and Properties. — A transparent, colorless, mobile, and volatile 
liquid, of a characteristic, rather agreeable odor, and a burning taste. Miscible with 
water, ether, or chloroform in all proportions. It is inflammable, and readily volatilized 
even at low temperatures. Alcohol should be kept in well-closed vessels, in a cool 
place, remote from lights or fire. 

Official Preparation. 

Alcohol Dilutum — Alcoholis Diluti — Diluted Alcohol (U. S. P.).— A liquid 
composed of about 41.5 per cent, by weight, or about 48.9 per cent, by volume, of 
absolute ethyl alcohol, and about 58.5 per cent, by weight of water. It should be 
kept in well-closed vessels, in a cool place, remote from lights or fire. 

Alcohol Absolutum — Alcoholis Absoluti— Absolute Alcohol (U. S. P.). — 

Definition. — Ethyl alcohol, containing not more than I per cent, by weight of 
water. 

Description and Properties.— A transparent, colorless, mobile, and volatile liquid, 
of a characteristic, rather agreeable odor, and a burning taste. Very hygroscopic. It 
should be kept in well-stoppered bottles or tin cans, in a cool place, remote from lights 
or fire. 

Spiritus Vini Gallici— Spiritus Vini Gallici— Brandy (U. S. P.). — Definition. 
— An alcoholic liquid obtained by the distillation of the fermented unmodified juice of 
fresh grapes. 

Description and Properties.— A pale amber-colored liquid, having a distinctive odor 
and taste and a slightly acid reaction. Its specific gravity should not be more than 
0041, nor le<s than 0.925, corresponding, approximately, to an alcoholic strength of 
39 to 47 per cent, by weight, or 46 to 55 per cent, by volume, of absolute alcohol. 

Spiritus Frumenti— Spiritus Frumenti— Whisky (U. S. P. ).— Definition.— An 
alcoholic liquid obtained by the- distillation of the mash of fermented grain, such as 
Indian corn, rye, wheat, and barley, or their mixtures. 

Description and Properties. — An amber-colored liquid, having a distinctive odor 

and taste and a slightly acid reaction. Its specific gravity should not be more than 

or less than o ^24. corresponding, approximately, to an alcoholic strength of 

37 to 47 per rent, by weight, or 44 to 55 per cent, by volume, of absolute alcohol. 

Whisky should be at least four vears old. 

Vinum Album— Vini Al'bi White Wine (U. S. P. . ■Definition.— An alco- 
holic liquid made by fermenting the juice of fresh grapes, the fruit of Vitis vinifera 
ord. Vitaeea), freed from seeds, stems, and skin.-, and subjected to the usual 
cellar-treatment for fining and aging. 

/'■■ -ripti n and Properties.— A pale amber-colored or straw-colored liquid, having 
a 1 1« free from yeastiness, and a fruity, agreeable, slightly spirituous taste, 

without ev or acidity. It should contain not less than 7, nor more 



THE ALCOHOLS. 143 

than 12, per cent, by weight— equivalent to 8.5 to 15 per cent, by volume— of abso- 
lute alcohol. 

Vinum Rubrum— Vini Rubri— Red Wine (U. S. P.)-— Definition.— An alco- 
holic liquid made by fermenting the juice of fresh red-colored grapes, the fruit of 
Vitis vinifera L. ( Vitacece), in the presence of their skins, and subjected to the usual 
cellar-treatment for fining and aging. 

Description and Properties. — A deep-red liquid, having a pleasant odor, free from 
yeastiness, and a fruity, moderately astringent, pleasant, and slightly acidulous taste, 
without excessive sweetness or acidity. It should contain not less than 7, nor more 
than 12, per cent, by weight— equivalent to 8.5 to 15. 3 per cent, by volume— of abso- 
lute alcohol. 

Unofficial Alcoholic Preparations. 

Spiritus Rectificatus— Spiritus Rectificati— Rectified Spirit— contains 85 per 
cent, by weight of absolute alcohol. 

Proof Spirit contains 49 per cent, by weight of absolute alcohol, together with a 
peculiar volatile oil and other foreign material. 

Gin is usually distilled in Holland from rye or barley, and flavored with juniper 
berries and hops. It contains about 42 per cent, by weight of absolute alcohol, and is 
probably more diuretic than other liquors because of the oil of juniper it contains. 

Rum is obtained by distilling fermented molasses, having about the same alcoholic 
strength as gin. 

Port Wine is prepared by adding spirit during the process of manufacture, bring- 
ing the alcoholic strength up to 30 or 40 per cent. 

Sherry Wine is a dry wine, having from 20 to 35 per cent, of alcohol. 

Sparkling Wines contain from 8 to 10 per cent, of alcohol. They are more or 
less sweet wines, and are charged with carbonic acid, being bottled before fermentation 
is completed, the grape-sugar, in consequence, not undergoing conversion into alcohol. 
The sparkling wines are champagne, hock, and sparkling catawba. 

Sweet Wines are those in which the sugar has not all been converted into 
alcohol, the alcoholic strength being therefore relatively low — from 6 to 7 per cent. 
Among the sweet wines may be classed Angelica, Madeira, Malaga, Muscatel, Tokay, 
etc. 

Dry Acid Wines are those in which the fermentation is complete, the alcoholic 
strength varying from 5 to 7 per cent. They are such as California Hock, Ohio and 
Kelly Island Catawba, Rhine and Moselle wines, Hochheimer, Durkheimer, Deides- 
heimer, etc. 

Light Red Wines contain 5 to 7 per cent, of alcohol, and are astringent, con- 
taining tannic acid and the coloring matter of the grape. They are Claret, Red Rhine, 
Concord, Hungarian, etc. 

Beer, Ale, and Porter are prepared by fermenting malted grain with hops and 
adding other bitters. Beer contains from 2 to 3 per cent, of alcohol ; ale and porter, 
from 4 to 6 per cent., besides carbonic and lactic acids, malt extract, various aromatics, 
and potassium and sodium salts. 

Cordials. — These are mixtures of distilled brandies with high sugar percentage 
added. The characteristic flavor is derived from volatile oils from the fruits or seeds 
added to the alcohol mixture before distilling. 

Physiological Action. — Few drugs have occasioned such diver- 
sity of opinion regarding their physiological action and uses as 
alcohol. 

Externally and Locally. — Ethyl alcohol is a distinct bactericide. 
Applied to the skin it is detergent, bactericide, and extracts water 
from the skin. When applied in full strength to the skin it pro- 
duces a sensation of coldness, due to rapid evaporation. Should 
the drug be diluted, the sensation of cold is greatly diminished. If 
evaporation be prevented, the effect is that of heat or burning, owing 
to the penetration of the drug through the epidermis and its chemi- 
cal influence upon the tissues beneath. 

Its effect upon the mucous membranes of the mouth and esoph- 



144 A TEXT-BOOK OF MATERIA MEDICA. 

agus is similar in kind to that upon the skin, save that the former 
are more readily affected. The mucous membrane becomes whitened 
and corrugated, because of the coagulation of albumin and the 
abstraction of water. A stimulation of the gastric functions is reflexly 
due to its local action in the mouth. 

Taken into the stomach there is a sensation of heat and marked 
increase of saliva, due to reflex action ; the blood-vessels of the 
stomach are dilated, with accompanying increase in the secretion of 
mucus and of the gastric juice. It is not certain whether pepsin is 
increased in amount or not. 

The action on digestion depends largely on the grade of concen- 
tration of the alcohol in the gastric contents and upon the individual. 
In general it may be said that in strengths up to 5 to 10 per cent, the 
digestive functions of the stomach are improved, although even this 
degree of concentration may partly destroy the action of the enzymes 
present. In strengths above 5 to 10 per cent., in some individuals 
even less, gastric digestion is interfered with. Alcohol increases the 
muscular activity of the stomach, and aids in the absorption of fluids 
from the stomach. 

The action of alcohol on the small intestines is not marked, since 
most of it is absorbed. When large amounts are taken, as at a 
large dinner, or during a debauch, diarrhea, in large part due to 
peristaltic stimulation, is a frequent symptom. 

Alcohol is rapidly absorbed and circulates in the blood. 

Nervous System. — The chief action of alcohol is on the nervous 
system. All portions of the nervous system are affected at once 
by the drug, but there seems to be a regular series of poisoning 
stages with well-recognized clinical signs. Thus it may be said that 
(a) the highest cerebral centers first show the toxic effects ; [b) the 
motor-conducting neurons come under the effect of alcohol next ; 
(c) the sensory centers then succumb, and (d), finally, the medullary 
centers of respiration and circulation are markedly involved. 

In the cerebral cortex the least highly organized of the faculties 
are primarily modified. The last of the evolutionary developments 
crumble first. Thus the finer ethical sentiments and regards for the 
proprieties become abrogated. Judgment becomes affected and 
bad bargains are made; stupid jokes are thought immoderately 
funny. Witty sallies are indulged in, which are usually flat. 

For certain individuals, particularly in some in whom inhibition is 
a powerful deterrent to speech and expression (for alcohol cuts off 
inhibition), and in others from the necessity for stimulus because 
of antecedent indulgences, alcohol is a powerful cerebral excitant. 
Under its milder influences such people are often thoroughly aroused 
and frequently can do their best work. Usually, however, such 
work, if unrevised, will show, and particularly for the genius of other 
than the first rank, many intellectual lapses, and it is highly doubtful 
if alcohol ever induces any real increase in the intellectual powers, 
save in the certain rare individuals mentioned. 

Following or coincidental with the breaking down of the higher 



THE ALCOHOLS. 145 

intellectual faculties there is a a weakening of the coordinating 
mechanism of motion. The fiber tracts do not react properly and 
irregularities of movement, in the lips in speech, in the eyes in wink- 
ing and seeing (double vision), in the arms in eating or drinking, in 
the legs in walking, are observed. 

Sensory disturbances, anesthesias, develop side by side with the 
other changes. An early loss of tactile impressions is apparent. 
The drinking man drops his cigar, or his knife or fork. His loss of 
muscle-sense contributes to his unsteadiness in walking, or in the 
movements of his arms. A general mild anesthesia contributes to 
the sense of well-being, since cold, fatigue, slight discomforts are no 
longer felt; hence one of the great attractions of this class of 
narcotics for all those who have painful conscious states. It affords 
an escape from present states of intense consciousness and is eagerly 
sought after. The urogenital sensory segments are late in sharing 
in the general anesthesia. 

In profound alcoholic narcosis the medullary centers are last 
seriously involved, the giving out of the respiratory center being the 
cause of death. Thus impaired consciousness, paresis or paralysis, 
anesthesia and respiratory failure summarize the march of the toxic 
action of this subject. 

Respiratory System. — Medicinal amounts deepen and accelerate 
respiration : large doses render the breathing slow and shallow — 
these effects being due to stimulation or depression of the respira- 
tory center. The stimulation may be secondary rather than 
primary, due in part to its action on the stomach walls. Death 
from a toxic dose of alcohol usually results from paralysis of respi- 
ration. It may be noted that under toxic dosage of the drug the 
amount of carbonic acid exhaled is diminished. 

Circulatory System. — Taken into the stomach, alcohol reflexly 
and rapidly stimulates the heart before absorption can take place, 
the effect upon the circulation persisting after the drug is absorbed. 
Cardiac action is rendered more rapid and forcible from small 
amounts, but it is not certain why. Arterial tension is raised, 
although the peripheral blood-vessels are dilated, especially those of 
the skin, owing to the depression of the vaso-constrictors. Toxic 
doses depress the heart and still further dilate the arterioles, greatly 
lowering the blood-pressure. This action of alcohol, in causing the 
heart to beat stronger and faster, at the. same time dilating the 
blood-vessels — particularly those of the peripheries — renders the 
drug one of the most diffusible stimulants. 

Excessive doses of alcohol greatly depress or paralyze the heart, 
while an enormous amount, -when taken upon an empty stomach, 
by reflex action occasioning cardiac paralysis, may produce instan- 
taneous collapse. 

Absorption and Elimination. — Alcohol is very rapidly absorbed, 
and eliminated unchanged in small proportion to the quantity in- 
gested, owing to the fact that the greater proportion of it is oxidized 
in the body. The kidneys, lungs, skin, and liver share in the excre- 
10 



146 A TEXT-BOOK OF MATERIA MEDIC A. 

tor\- process. It is estimated that at least 90 per cent, is oxidized. 
The products of oxidation are not definitely known, but they are 
assumed to be acetic acid and C0 2 and H 2 0. 

Kidneys. — Alcohol increases the amount of urine formed. The 
causes are partly due to increased blood-flow, a slight increase in 
pressure, and perhaps some direct action on the epithelium. Single 
large doses are known to cause albuminuria, and chronic kidney 
changes are almost universal in chronic alcoholism. Uric acid 
secretion does not seem to be modified. 

Temperature. — Alcohol is an antipyretic of considerable power. 
This action is owing largely to the cooling of the blood through 
dilatation of the cutaneous blood-vessels, subjecting the warm blood 
from the interior of the body to the cooling influence of the atmos- 
phere, and to the cooling of the surface of the body from the evapo- 
ration of sweat. The power to resist cold is diminished by the 
habitual use of alcohol. The drug would be useful in stimulating 
warmth in a person who had been long exposed to cold, but only 
in a warm room. Then, by rapidly dilating the blood-vessels of the 
skin and allowing the blood to flow to the surface, the subject is 
favorably affected by the external heat, while there is less danger 
of congestion in some internal orsran. 

Metabolism. — The action of alcohol in metabolism is intricate. 
Its many factors have not yet been determined with accuracy. Its 
rapid absorption and subsequent rapid oxidation brings about an 
increase in the energy of combustion, and thus alcohol may up to a 
certain point take the place of certain food elements of the body. 
Neumann, Atwater, and others have almost conclusively proved 
that alcohol may be said to save the proteids, and temporarily take 
the place of carbohydrates and fats as foods. Neumann's classical 
experiment is worth bearing in mind in this connection. It is 
known that in the absence of carbohydrates and fats in the diet, the 
proteid elements of the body are burned in their place. This is 
made evident in an increase of nitrogen elimination from the urine; 
and conversely when surplus quantities of fats and carbohydrates 
an supplied the nitrogen elimination falls. This general result 
served as a criterion in a series of experiments in which alcohol was 
given in the place of fats more particularly and the results on the 
nitrogen elimination noted. Thus in the experiment referred to a 
time schedule of thirty-five days, divided in six periods, was followed 
out. Under a constant diet for five days a nitrogenous equilibrium 
first established; then for four days the amount of fat was 
reduced one-half; this resulted in an immediate and steady increase 
in the amount of nitrogen eliminated, showing that the proteids 
being used to supply the fat deficiency. At the end of this 
'1 period alcohol calorically equivalent to the omitted fat was 
added. After a short period the nitrogen elimination commenced 
to diminish and at the end of ten days had sunk to the level of the 
equlibrium line. At this time the full amount of fat, plus the 
alcohol, '.'..i- resumed, and the nitrogen elimination became less 



THE ALCOHOLS. 147 

than before, thus showing that the alcohol had taken the place of 
a certain amount of fat and spared the proteid. The experiment 
terminated by a resumption to former conditions when the nitrogen 
equlibrium was once more attained. 

A similar lesson may be learned from the obesity of alcohol 
users. These accumulate fat because the addition of the alcohol 
supplies a readily oxidizable substance and the normal fat is not 
called on for purposes of combustion. 

In some particulars alcohol retards certain combustions, inter- 
fering at times with the full oxidizing properties of the liver cells, 
but the precise limits of activity are inadequately known. 

In reference to the action of alcohol on the protective agents of 
the blood-plasma the evidence is inconclusive. It seems fairly well 
established that continued alcohol-taking reduces the resistance of 
the body to infections, but it also seems probable that in infectious 
diseases, for the non-alcoholic, alcohol contributes in some manner 
to the antitoxic properties of the blood serum. The studies on this 
subject, however, are far from being conclusive. 

Untoward action is fully described under " Poisoning." 

Poisoning. — The untoward or poisonous action of alcohol may 
be divided into what are known as Acute and Chronic Alcoholism. 

Acute Intoxication. — The general physiological phenomena lead- 
ing up to acute poisoning by alcohol have been discussed, but the 
clinical picture, while too familiar, may be of service in differential 
diagnosis. The patient thoroughly under the influence of the drug 
is lying prostrate, usually in a more or less loose and lax position. 
His clothing is apt to be much awry and soiled and frequently wet 
with urine from the diuresis and gradual increase of loss of ability 
to control the acts of toilet. On inspection the face is found either 
flushed and warm in the lighter or early forms of intoxication, or 
cold and cyanosed in the deep narcoses. The breathing is deep 
early; or shallow and stertorous later; always in this condition 
slower than normal (8-10 per minute), in contrast to 5-6 per min- 
ute for severe opium poisoning. The pulse may be full and normal 
in rate, or in the very severe grades small and thin and wiry. The 
body temperature by rectal thermometric reading is reduced inva- 
riably 1 to 2 or even 4 F. The eyes are suffused and bloodshot, 
the pupils moderately contracted or dilated, depending on the depth 
of the narcosis. In fatal cases wide dilatation is the rule. The mouth 
is apt to be moist unless long exposure and stertorous breathing 
have dried it. An odor of alcohol is present. Too much stress 
should not be laid on this odor. Mistakes are too often made in 
the diagnosis between fractured skull and alcoholism because the 
breath smells of alcohol. Great care must be taken when the two 
conditions are present. Further examination of the patient will 
show him difficult or impossible to arouse, and only by pressure on 
a prominent nerve trunk can a response be obtained. The knee- 
jerks are abolished, and may be the corneal reflex. Catheterization 
of the bladder usually reveals a comparatively full bladder, and the 



148 A TEXT-BOOK OF MATERIA MEDICA. 

urine does not contain any copper-reducing substances — compare 
with chloral poisoning- ; diabetes ; some skull fractures. 

A type of subacute alcohol poisoning is known as Delirium 
tremens. It usually follows a bout of heavy continuous drinking. 
Its onset may be gradual ; or following an injury \ psychical or phy- 
sical shock, or even an attack of infectious disease, the train of 
symptoms may develop very rapidly. Thus in some of this latter 
type acute delirium tremens may follow immediately after a fracture 
or during an attack of pneumonia. Sudden grief may also pre- 
cipitate an attack. 

In the gradual cases the early symptoms are those of gradually in- 
creasing restlessness ; the patient must be up and doing. Wakeful- 
ness or insomnia develops and the patient loses his appetite. Mus- 
cular tremor of a very fine type, or occasionally muscular twitching 
or jerking, may be present There is an increase in all of the 
patient's reflexes. Irritability is marked, and from the increasing 
meningeal or cerebral irritation visual and auditory hallucinations 
begin to develop. At first these are absent in the daytime, and only 
become bothersome as the patient retires, but later the hallucina- 
tions become more marked. They often are representative of the 
patient's regular occupations ; but more classically the visual hallu- 
cinations are terrifying in their character — sometimes of the night- 
mare order — frequently of animals, etc. From this condition, the 
cerebral irritation progressing, acute maniacal delirium develops. 
This may end by a fatal collapse. 

Chronic alcoholism is generally the result of the continuous and 
excessive use of alcohol. The symptoms vary according to the 
individual case. There may be (1) the moderate, daily drinker; 
(2) the periodical inebriate, usually the highly gifted, sensitive, and 
sympathetic, who drinks to excess at certain distinct intervals with 
a deliberation and moral perversity expressed by the declaration of 
a noted British general : " By the blessing of God, I intend to get 
gloriously drunk next Saturday night;" (3) the immoderate, impul- 
sive, maniacal inebriate, who, during his usually brief existence after 
the establishment of the disease, is subject to constant and excessive 
indulgence, incapacitating him from the simplest duties of a rational 
life. 

The habitual drinker sooner or later suffers from disturbed diges- 
tion, gastric catarrh, and irregularity of the bowels; his face is 
usually puffed and bloated, while the capillaries, especially of the 
cheeks and nose, become permanently dilated, marked acne rosacea 
not infrequently developing in the latter organ. 

The description of types of alcoholic psychoses should besought 
for in works on psychiatry. These psychoses are of immense prac- 
tical importance. 

Pathological changes induced by chronic alcoholism are very 
numerous. Chronic congestion and irritation of the stomach lead 
to catarrhal gastritis. In the liver new connective tissue forms, par- 
ti' ilarly in the acini most in contact with the alcohol undergoing 



THE ALCOHOLS. 149 

combustion. Chronic cirrhosis results with its train of symptoms : 
ascites, jaundice, biliary infections, etc. Fatty degeneration is com- 
mon. The circulatory changes are prominent. In beer-drinkers, 
particularly in those who drink large quantities, there is cardiac 
dilatation and hypertrophy with degeneration. These patients, 
usually workers connected with brewing industries, develop the 
so-called " beer heart." The alcohol, plus the large amounts of 
water, dilates the stomach ; thereis irregular and slow, or galloping 
pulse, with dyspnea and cyanosis. ' 

The continued heart strain leads to myocardial degeneration and 
to fatty changes. Vessel changes of an arteriosclerotic nature are 
also present. In the kidneys the vascular changes are the most 
important factors. These lead to kidney inefficiency, and the irrita- 
tion or suboxidation to new connective tissue formations, with the 
development of chronic forms of nephritis. 

The nervous tissues are profoundly affected. Changes in the 
peripheral nerves, nerves of trophic influences, spinal cord, optic 
nerve, and brain are frequent. In the peripheral nerves a neuritis 
may develop, leading to isolated paralyses or anesthesiae, or to 
multiple neuritis and general peripheral sensory disturbances. Alco- 
holic paralysis usually affects the extensors, causing wrist-drop and 
foot-drop, and is, as a rule, accompanied with some sensory disturb- 
ances (see Lead Palsy, Arsenical Neuritis). Trophic disorders, 
herpes, urticaria, ulceration, etc., are not uncommon. In the spinal 
cord a partial degeneration of the sensory neurons of the posterior 
columns leads to a pseudo-tabes, the symptoms closely resembling 
those of locomotor ataxia. In the eye partial or complete blindness 
may occur, amblyopia and amaurosis being particularly prevalent 
following the use of methyl alcohol. Scotomata are common, par- 
ticularly in reds and greens. In the brain an acute psychosis — 
delirium tremens — may be set up, or a slow grade of alcoholic 
dementia supervene. 

Treatment of Acute Alcoholic Poisoning. — The stomach should be 
emptied of all unabsorbed alcohol ; cautious inhalations of ammonia 
should be given, accompanied by the internal administration of 
black coffee. The patient should be put in warm blankets, made 
to perspire freely, and if there is great danger of collapse, artificial 
respiration should be practised and strychnine should be adminis- 
tered. Alcohol derivatives should be avoided. 

Treatment of Delirium Tremens. — The management of this phase 
of alcoholism requires great skill and judgment. The main indi- 
cations are : 

(1) Elimination. — By diaphoresis, catharsis, diuresis, warm 
baths, etc. 

(2) Support. — Some alcohol may be necessary. Easily digested 
food. Enemata if necessary. 

(3) Quiet. — Hypnotics : opium, chloral, bromides. 
Treatment of Chronic Alcoholism. — A thoughtful and extended 

experience with inebriates will convince most observers that the great 



150 A TEXT-BOOK OF MATERIA MEDICA. 

majority of dipsomaniacs suffer from a disease possessing usually a 
distinct and traceable etiology, and resulting from either inherited 
or acquired neurosis. In many cases the malady is characterized 
by uniform development, progress, symptomatology, and termina- 
tion. 

The medicinal agents most serviceable in the treament of chronic 
alcoholism are strychnine, atropine, small doses of the alteratives, 
arsenic, potassium iodide, and mercury, while phosphorus and other 
restoratives and tonics will frequently be found useful. 

The hygienic surroundings should be of the best, and the treat- 
ment should include a nutritious, non-stimulating diet taken with 
regularity, and the free use of fruits and vegetables. Close attention 
should be paid to the condition of the bowels and skin, and among 
other remedial influences should be mentioned laxatives when neces- 
sary, frequent Turkish baths, and, above all, change of scene and 
engaging mental occupation. 

From time to time various drugs have been heralded as specifics 
in the treatment of alcoholism, certain " cures " (sic) acquiring an 
influence among the ignorant and unscientific wholly at variance 
with therapeutic value of these vaunted remedies. It is superfluous 
to say that for a skilled and enlightened professional judgment the 
rationale of intemperance and the agents serving to mitigate the 
malady present a problem far too complicated to be grasped by the 
empirical understanding, operating even under the most ingenuous 
motives. 

Therapeutics. — Externally and Locally. — Alcohol is an efficient 
application for contusions, strains, and indolent ulcers, and is also 
serviceable in hardening the skin and preventing the formation of 
bed-sores. It is a useful hemostatic to check capillary oozing, and, 
being a powerful antiseptic, is available in all wounds. -Uterine 
hemorrhage is controlled by inserting in the cavity of the uterus a 
tampon saturated with the drug. 

Its local anesthetic properties render alcohol valuable in relieving 
irritation of the skin in urticaria, frost-bite, etc.; it also serves as an 
efficient gargle in diphtheria and acute pharyngitis. 

Alcohol is an excellent local application to counteract the caustic 
action of carbolic acid. 

Alcohol, or brandy, has been successfully employed to harden 
nipples and prevent their cracking. 

A very efficient means of reducing temperature in fever is to 
bathe the skin with alcohol, the method being also useful to check 
ssive sweating. 

The absorption of inflammatory exudates may be aided and the 
pain of muscular rheumatism relieved by rubbing the affected area 
with TlNi TURE OP camphor or soap LINIMENT, both of which con- 
tain alcohol. 

Internally. — ALCOHOL, in the form of wink, BEER, or ale, taken 
before or during meals, is an efficient stomachic. Atonic dyspepsia 
and the weakened digestion attendant upon convalescence from acute 



THE ALCOHOLS. 151 

diseases are greatly benefited by some form of alcohol. When 
digestion becomes impaired as the result of physical or mental 
exhaustion the drug serves a useful purpose as a tonic. In percent- 
ages above 10 per cent, alcohol hinders, rather than aids, digestion. 
It is obviously contraindicated in gastritis. 

The wisdom of using the drug, however, in the conditions men- 
tioned may be questioned, because of the danger of establishing the 
desire or habit, particularly in the case of neurotic women and 
those whose debilitated energies call for renewed and increasing 
quantities of the drug. 

Frequently the physical or mental depression, the peculiar, irre- 
sistible craving for stimulants, the insomnia and fitful appetite and 
disposition which urge recourse to alcoholic indulgence, are but the 
early manifestations of a brain-and-nerve degeneration, the impulse 
to drink being only the physical demand for relief. 

There is less danger attending the administration of alcohol in 
conditions of lowered vitality and weakened digestion in old people 
than in the young and middle-aged. The drug is decidedly contra- 
indicated in persons of average health and fair digestion, although 
beneficial in the aged, whose powers are failing from natural decline. 

The anesthetic and sedative properties of alcohol, especially in 
the form of champagne, which contains carbon-dioxide gas, may 
frequently control obstinate vomiting. Gastralgia and the pain 
arising from flatulence are often readily relieved by brandy. 

As a pure cardiac stimulant, alcohol is remarkably serviceable 
in syncope, asphyxia, exhausting hemorrhages, diphtheria, and collapse 
where death seems imminent. In counteracting the effects of nar- 
cotic poisons it is almost indispensable; it is of some service for the 
treatment of poisoning by venomous reptiles, but it is not a specific in 
any degree. 

It is a common practice with some surgeons to precede the 
inhalation of chloroform with the administration of 1 or 2 ounces 
(30.0-60.0 Cc.) of whiskey or brandy, to induce a partial anesthesia 
before giving the general anesthetic. 

In certain stages of various acute diseases, such as typhoid, 
typhus, small-pox, pneumonia, cerebrospinal meningitis, capillary 
bronchitis, etc., alcohol is one of the most potent and valuable reme- 
dies. It should be employed in these cases only when there is 
marked depression of the circulatory apparatus, characterized by 
a weak, rapid, soft, and irregular pulse with a feeble sound of the 
heart and threatened syncope of delirium. 

Alcohol is beneficial in such cases as the foregoing when by 
its use the tongue is moistened, the pulse and respiration are slowed, 
the restlessness and delirium quieted, and the skin becomes less 
parched. 

Should the drug increase the pulse rate and intensify the nervous 
manifestations, it is an indication that the dosage is excessive, in 
which event it may be well to discontinue the administration alto- 
gether. Even where the action of the druo; is favorable, it is 



152 A TEXT-BOOK OF MATERIA MEDICA. 

doubtful whether it should ever be given in fevers throughout the 
twenty-four hours, administration being advisable rather when the 
muffled or absent first sound of the heart indicates impending cardiac 
failure. This usually occurs during the interval between midnight 
and 7 a.m. Stimulation should therefore begin before midnight, 
and full doses — say I fluidounce (30 Cc.) — be given every three 
hours, full doses being of more service than repeated smaller 
amounts. 

It should be remembered that alcohol generates no new energy, 
but simply enables a person to utilize in a short period all his 
available reserve force. The utmost discrimination and judgment 
are requisite to the proper administration of the drug. 

In pyemia, septicemia, erysipelas, and diphtheria alcohol is fre- 
quently one of our most efficient remedies. Experience tends to 
show that tuberculous patients for the most part get along better 
without alcohol. 

Small quantities of alcohol appear to exert a favorable action in 
functional impotence. 

Its sedative action, or possibly its property of increasing intra- 
cranial blood-pressure, renders alcohol valuable as a hypnotic in 
mild insomnia, particularly in old people. It may be useful in 
some cases of insomnia if the patient does not continue to work. It 
is a very useful hypnotic in the delirium of acute infectious diseases. 

In cardiac disorders alcohol is often very useful. In syncope, 
shock particularly. In acute colds which are largely local circu- 
latory disturbances, alcohol may restore balance. 

Contraindications. — In genito-urinary affections alcohol does 
more harm than good. It is ordinarily contraindicated in nephritis 
and diseases of the liver, gout, gleet, gonorrhea, and in urethritis. 
The malt liquors and sweet wines should not be given in diabetes 
nor to persons suffering from eczema. Alcohol is also dangerous 
in hypertrophy of the heart and excessive cardiac action. 

Administration. — When possible, alcohol should always be 
taken with food. Brandy is the best astringent, and brandy and 
champagne are the best preparations to allay nausea. Whiskey is 
the least constipating, and gin the most diuretic. As regards their 
sedative action, there is no preference, whichever is most agreeable 
to the patient and least affects the head being advisable. As stom- 
achics cither claret, beer, or ale is most efficacious in improving the 
appetite. In cases of fermentative dyspepsia sweet wines and 
malted liquors are more injurious than beneficial, whiskey or brandy 
being preferable. 

When desired as diffusible stimulants in cases of cardiac failure, 
brandy or whiskey only should be employed, which preparations 
may be given hypodermically, 

Antagonists and Incompatibles. — The motor, cerebral, and 
cardiac depressants are antagonistic to moderate amounts of alcohol. 

Syi 3. — The motor excitants, atropine, ether, and the dif- 

fusible stimulants. 



GENERAL ANESTHETICS. 153 

GENERAL ANESTHETICS. 

Ether, chloroform, and a number of related compounds, ethyl 
chloride, methylene chloride, etc., form a group of these alcohol 
derivatives, in which the property of rapid volatilization causes the 
formation of vapors which are capable of rapid absorption by the 
respiratory mucous membrane with the production of general anes- 
thesia. Nitrous oxide causes a similar anesthesia, but its mode of 
action is very dissimilar. 

To Dr. Oliver Wendell Holmes is due the credit of proposing 
the term " anesthetic." This group occupies a position between 
the preceding one and the next — Hypnotics. 

The use of drugs to abolish pain in surgical operations has 
probably never been entirely forgotten, but their general and sys- 
tematic employment only commenced with the use of nitrous oxide 
by Wells, in 1844, and of ether by his pupil Morton. Shortly after- 
ward a great number of substances were tried by Simpson, with the 
result that he chose chloroform as being the most convenient and 
safe. The power of producing anesthesia, as already pointed out, 
is common to most of the substances of the fatty or alcohol series. 
But it is greatly modified by a number of circumstances ; the position 
in the fatty or alcoholic group of the radical or alkyl which forms 
the basis of the substance, and the nature of the element or radical 
with which the alkyl is combined, being two prominent ones. Thus 
in the case of the alkyls, their action differs according as they are 
combined with hydrogen in the hydrides, with hydroxyl, OH, in 
the alcohols, or with both oxygen and hydroxyl, as in the acids. 

Some members are useful as hypnotics, simply inducing sleep 
as one of the first results of their action ; although if the dose be 
large, the sleep may pass into complete unconsciousness or anes- 
thesia, with loss of reflex action. For the production of prolonged 
sleep a substance is required whose action will be slight, and at the 
same time prolonged ; but for anesthesia a substance is needed that 
will act rapidly and powerfully, but will be quickly eliminated and 
cease to act very shortly after its administration is discontinued. 
Hypnotics therefore are found among the substances which have a 
heavy molecule, and are either liquid or solid in form, so that they 
may be given by the mouth, and being absorbed into the blood 
continue to act for a length of time. Anesthetics are found among 
the lower members of the series which have a light molecular 
weight, and are either gases or volatile liquids. Although heavy 
liquids like paraldehyde, or solids like chloral hydrate, will act as 
anesthetics when given in large doses, yet their use as such would 
be very dangerous, for the line between their anesthetic action and 
their paralyzing action on the respiratory center is very narrow and 
might easily be crossed by a very slight excess in dose. 

An ideal anesthetic should be a substance capable of rapidly and 
safely producing profound anesthesia, and susceptible of speedy 
elimination, so that consciousness may be restored soon after with- 



154 A TEXT-BOOK OF MATERIA MEDICA. 

drawal of the anesthetic, with no discomfort to the patient. The 
typical anesthetic should also be convenient and safe — a stable, 
non-irritating, pleasantly odorous, homogeneous liquid, with a 
boiling-point neither too high nor too low. Unfortunately there is 
no substance which fully meets these requirements, ether and chlo- 
roform approaching nearest to the ideal agent. 

Local anesthetics are used to deaden the sensation or abolish 
the sensibility of the peripheral nerves of a localized, particular 
area. The most important are — cocaine, carbolic acid, iodoform, 
eugenol-acetamide, antipyrine, orthoform, anesthesin, holocaine, etc. 
Some aromatics are also quite powerful anesthetics. The physio- 
logical action of local anesthetics is given under the respective 
agents. 

^Ether—^Etheris— Ether. V. S. _P. 

Origin. — A liquid composed of about 96 per cent, by weight of absolute ether or 
ethyl oxide, [(C 2 H 5 ) 2 = 73.52], and about 4 per cent, of alcohol containing a little 
water. 

Description and Properties. — A transparent, colorless, mobile liquid, having 
a characteristic odor and a burning, sweetish taste. Specific gravity, 0.7 16-0. 7 17 at 
2 5° C. (77° F.). Soluble in about ten times its volume of water, with slight contraction 
of bulk. Miscible, in all proportions, with alcohol, chloroform, petroleum, benzin, ben- 
zene, and fixed and volatile oils. 

Ether is highly volatile and inflammable, its vapor, when mixed with air and ignited, 
exploding violently. It should be kept in well-stoppered containers, preferably in tin 
cans, in a cool place, remote from lights or fire. 

Dose, 15-40 minims (1.0-4.0 Cc. ) [15 minims (1 Cc), U. S. P.]. 

Official Preparations. 

Spiritus Athens — Spiritus ,/Etheris — Spirit of Ether. — Dose, %-\ fiuidrachm 
(1.0-4.0 Cc). 

Spiritus Athens Compositus — Spiritus Athens Compositi — Compound 
Spirit of Ether (Hoffmann's Anodyne) —Ether, 325 ; alcohol, 650; ethereal oil, 
25 parts. Dose, 5-60 minims (0.3-4.0 Cc). 

Physiological Action. — Externally and Locally. — Ether when 
applied to the skin produces intense cold by its rapid evaporation. 
If it is confined and its evaporation prevented, great irritation is 
caused. By spraying a part with ether it becomes quickly frozen, 
marked local anesthesia being produced thereby. 

Applied to mucous membranes, it creates considerable irritation, 
especially of the fauces and respiratory tract when inhaled. 

Internally. — Digestive System. — It is a carminative, increasing 
peristalsis and the secretions from the pancreas and the salivary 
and gastric glands, at the same time dilating the vessels of the 
stomach. 

Nervous System. — Ether first occasions a considerable degree of 
excitement, due to the direct action of the ethyl upon the cerebral 
cortex. Its action on the cerebrum is similar to that of alcohol, 
and ii'( (1 not be recapitulated. The action is much more rapid. 
The stages are all compressed and hence somewhat accentuated. 
Thus the excitement of the second stage is distinctly comparable 



GENERAL ANESTHETICS. 155 

with the incoherence and exuberance of the partially intoxicated 
individual. 

Circulatory System. — When taken into the stomach ether re- 
flexly stimulates the heart in a manner similar to that of alcohol, 
raising arterial tension by increasing the force and frequency of the 
heart's action. 

Ether stimulates the heart and increases the blood-pressure when 
inhaled. It is a diffusible, rapid, and reliable cardiac stimulant. 

Respiratory System. — Medicinal doses stimulate and poisonous 
doses paralyze the respiratory center. 

Respiration is frequently arrested at the beginning of ether- 
inhalation, owing to reflex spasm arising from irritation of the 
peripheral ends of the vagi and trigemini. As the inhalation is 
continued the breathing becomes deeper and slower from stimula- 
tion of the respiratory center. This part of the nervous system 
may, in fact, become exhausted from over-stimulation, when the 
respirations are slow and shallow. 

In fatal cases of ether-narcosis the respiration is usually arrested 
before the cessation of the heart's action. 

Absorption and Elimination. — Ether is rapidly eliminated, chiefly 
by the lungs, but also by the kidneys, which are often considerably 
irritated by the process. 

Temperature. — The prolonged administration of ether produces 
a great reduction of temperature — doubtless due to the depression 
of the circulation and respiration and the rapid evaporation of the 
drug, chilling the body and lungs, rather than to any direct action 
upon the nervous mechanism presiding over the heat-centers. 

In brief, the action of ether when inhaled may be divided into 
3 stages for purposes of description. They merge one into another, 
and in many individuals great variations exist. These may be termed 
the stage of (1) impaired consciousness, (2) excitement, (3) anesthesia. 
At first a sensation of choking and irritability of the respiratory 
mucous membrane is experienced. A greatly increased activity of 
the salivary glands follows, accompanied by a sensation of prick- 
ing or tingling of the hands and feet. The conjunctiva is injected, 
the face is flushed, the veins of the neck are distended, and there 
is experienced a peculiar feeling of lightness, together with the 
beginning of impairment of consciousness. Seeing and hearing 
are altered, slight insensibility is present, and is sometimes utilized 
for slight operations. Following this first short period the stage 
of excitement is usually ushered in by muscular twitchings or 
muscular struggles. The patient may yell, laugh, cry, curse or 
pray, struggle or become pugilistic or sometimes amorous. The 
respirations are usually quickened and irregular from the struggling, 
and the pulse is rapid and irritable. The pupils are usually dilated. 

The stage of anesthesia is usually indicated by muscular relax- 
ation. The patient becomes quiet. The breathing becomes more 
regular and slower ; the heart becomes steadier and slower. The 
reflexes are abolished, the genital and conjunctival reflexes last in- 



156 A TEXT-BOOK OF MATERIA MEDIC A. 

volved, and complete anesthesia and unconsciousness with mildly 
contracted pupils indicate the full action of the anesthetic. 

If the inhalation be discontinued before a toxic quantity of ether 
has been administered, consciousness gradually returns — in some 
cases almost at once, although some loss of sensation and muscular 
weakness remain for a while. 

The return of consciousness is usually accompanied by retching 
and vomiting — often by severe rigors, unless care has been taken 
to keep the patient warm. Great excitement not infrequently 
attends this stage of etherization. 

Treatment of Untoward Manifestations. — Withdraw the ether if 
there be danger of respiratory or cardiac failure, lowering the head 
if there be indications of the latter, and if respiratory failure be 
threatened, as indicated by cyanosis, avoiding a prostrate position. 
Meanwhile other measures for the relief of cardiac or respiratory 
failure may be resorted to : artificial respiration, friction, or the 
electric current to excite respiratory action, one electrode being 
placed upon the larynx and the other upon the epigastrium. Hy- 
podermic injections may be resorted to — of strychnine, or atropine, 
or, in desperate cases, of ammonia. Salt infusion may be used. 
Adrenalin is useful to restore blood-pressure. 

Should nausea become too persistent, a hypodermic injection of 
morphine will usually suffice to quiet it. 

Therapeutics. — Externally and Locally. — The local anesthetic 
properties of ether render it valuable in many diseases of the skin, 
such as pruritus, urticaria, etc. For treatment of these disorders 
it is usually combined with some aromatic. 

A wet compress saturated with ether has been successfully 
applied to the forehead for the relief of epistaxis. The hypodermic 
injection of 1 5 minims ( 1 o Gm.) of ether in close proximity to 
the affected nerve has been found valuable in neuralgia and sciatica. 

The hypodermic method of administration has been also prac- 
tised in the treatment of shock and in the threatened collapse fol- 
lowing post-partum hemorrhage, as well as for the cure of sebaceous 
cysts. 

Internally. — Ether is used as an antispasmodic in order to facili- 
tate certain examinations, the reduction of dislocations, and to 
relieve pain in the general practice of surgery, obstetrics, and den- 
tistry. It has been used as an anthelmintic against tapeworms. 

The compound spirit of ether is a stimulant, antispasmodic, 
and anodyne. It is an efficient remedy for gastralgia and flatulent 
colic, and is used to allay many of the symptoms of hysteria, as well 
stlessness and insomnia unaccompanied by fever. Palpitation of 
the heart and nausea due to the excessive use of tobacco are also 
greatly benefited by this preparation. In angina pectoris and hic- 
cough it is an efficient remedy. 

Contraindications. — Acute or chronic disease of the kidneys. 

n or fatty degeneration of the heart. Subacute bronchitis. 

letimes. Tuberculosis with tendency to hemorrhage. 



GENERAL ANESTHETICS. 157 

Tumors of the brain or about the neck. Atheromatous condition 
of the arteries. Enlarged tonsils, chronic alcoholism, or aneurism. 

It is necessary at times to give an anesthetic in the foregoing 
cases, and the surgeon is justified in the use of ether, but the 
administration should be extremely careful and conducted under 
skilful supervision whenever the above contraindications exist — 
particularly in conditions of dilated or fatty heart or chronic alco- 
holism. Any condition which might prove harmful by reason of 
the retching and straining, as hernia, etc., sometimes constitutes a 
contraindication. 

Administration. — In administering anesthetics the following 
precautions should be taken: 

The stomach of the patient should contain no food. 

The clothing should be loose about the neck, thorax, and abdo- 
men, allowing perfect freedom of respiration. 

Artificial teeth should be removed. 

It should be remembered that ether is inflammable, and, when 
its vapor is mixed with air, explosive ; it should, therefore, not be 
used near a flame or an actual cautery, from which it may ignite. 

The patient should be kept covered, in order that there may not 
be too great a reduction in temperature. He should, moreover, be 
watched for several hours after the administration, since there is 
always more or less danger until the effects of the ether have 
entirely disappeared. 

Under proper methods the administration of ether occasions 
little inconvenience. In addition to the recommendations already 
given, it may be added that smearing the mouth and nose with 
oil prevents the excoriation frequently occasioned by contact with 
the anesthetic. 

There are various means of administration, the simplest and in 
many cases the most efficient being a towel shaped into a funnel or 
hollow cone, with a piece of stiff paper laid between the outer folds 
to preserve the shape. Many other mechanical contrivances are in 
use. The Allis inhaler is widely used, although the tendency is to 
use more complicated inhalers. 

In using the towel-cone the inner surface is saturated with 
about half an ounce of ether, the inhaler at first not being placed 
close to the mouth and nose, thus allowing the vapor to be suffi- 
ciently diluted with air. The effect of this method is to accustom 
the air-passages to the primary irritation of the anesthetic and 
graduate its effects. It should be borne in mind that poisoning 
occurs in. both ether and chloroform anesthesias by reason of too 
concentrated a vapor. Ether should not be administered in more 
than 6-10 per cent, of vapor. Chloroform vapor should be much 
more diluted — 1—2 per cent. After this the towel may be pressed 
closer to the mouth and nose and the vapor of ether freely admin- 
istered. In this manner a person may become completely etherized 
without nausea or resistance. The insensibility of the conjunctiva and 
complete relaxation of the muscles, accompanied by semi-stertorous 



158 A TEXT-BOOK OF MATERIA MEDICA. 

breathing, indicate that the stage of desirable anesthesia is attained. 
The quantity of ether administered should now be reduced, further 
supplies being limited to the amount requisite to maintain com- 
plete anesthesia. 

The symptoms incident to the primary effects of etherization — 
cerebral excitement, muscular activity, etc. — should not induce 
withdrawal of the anesthetic, but rather its continuance. Should 
vomiting occur at this stage, etherization should be suspended 
and the mouth thoroughly cleansed by means of a sponge or a 
towel. 

Complete loss of consciousness marks the following stage of 
anesthesia, when total relaxation supervenes, accompanied by gen- 
tle, regular breathing. Should stertorous respiration attend further 
etherization, it is a warning of paresis, and the drug should be 
withdrawn. 

Congestion of the facial muscles during anesthesia is quite 
normal, pallor, as a rule, indicating cardiac or respiratory debility. 
The practice of closely covering the face is thus to be discouraged, 
since it conceals important symptoms of the patient's physiological 
condition. The danger from asphyxia in complete etherization is 
shown by the entire muscular relaxation of the tongue, which is 
prone to drop backward, and the closing of the glottis, suspending 
respiration. In such an occurrence the jaw should be pressed for- 
ward, the head being well extended, and, if necessary, the tongue 
brought forward with the forceps. 

The pulse, respiration, color, and pupillary reflex are the main 
points under observation by the anesthetist. At first the rate of 
the pulse is usually increased by reason of excitement ; later it 
becomes slower and fuller, and when it becomes very slow and 
feeble, it is wise to ease the patient. The respirations, after the pre- 
liminary choking and gagging, become full, deep, and slower. As 
anesthesia progresses they become shallower and shallower, and 
should always be watched with a critical eye, especially if cyanosis 
develops. This indicates the danger-limit to which etherization 
may proceed. The pupils exhibit a variety of changes and differ in 
every individual. The usual rule is to have a preliminary dilatation,, 
and during narcosis a moderate state of contraction. If marked 
dilatation occurs in deep narcosis, this is an indication of poisoning 
and for the withdrawal of the anesthetic. 

Under favorable conditions, from five to twelve minutes are re- 
quired to etherize the patient completely. The effects of anesthesia 
upon recovery vary with the temperament and character of the 
individual and the conditions under which the drug is administered. 
Great excitability may attend awakening from etherization, or the 
patient may return to consciousness as from a tranquil slumber. 
Nausea and vomiting frequently accompany rallying from the 
narcosis — not, however, such as may require especial treatment. 
Should somnolence be manifested, it is best not to rouse the patient, 
that the awakening may be easy and natural. 



GENERAL ANESTHETICS. 159 

In etherizing a female patient the presence of a woman is always 
desirable, in order that her testimony may assuage certain sexual 
impressions to which women during anesthesia are prone. To the 
operator and attendants her presence is also of importance. 

In collapse states hot applications, the internal administration 
by hypodermic of caffeine, strychnine, ergot, or adrenalin chloride 
are each, and may be all, called for. Artificial respiration is impera- 
tive ; oxygen often helpful, and enteroclysis with hot saline, or 
infusion may be useful. Suprarenal extracts may be of service. 

Great care should be taken to see that the patient is well cov- 
ered and not exposed to drafts, in its relaxed condition the body 
being peculiarly susceptible to pneumonia or pleurisy. The anes- 
thetic should be carefully examined before administration, and the 
character of the drug thoroughly known. 

Chloroformum— Chloroformi— Chloroform. U. S. P. 

Definition. — A liquid consisting of from 99 to 99.4 per cent., by weight, of abso- 
lute chloroform, and from 0.6 to I per cent, of alcohol. 

Description and Properties. — A heavy, clear, colorless, mobile, and diffusible 
liquid, of a characteristic ethereal odor and a burning taste. Specific gravity, not below 
I.476. Soluble in about 200 times its volume of cold water, and in all proportions in 
alcohol, ether, benzene, petroleum benzin, and fixed and volatile oils. 

Chloroform is volatile, even at a low temperature, and boils at 6o° to 6i° C. (140 - 
141. 8° F. ). It is not inflammable, but its heated vapor burns, emitting a green flame. 
It should be kept in dark, amber-colored, glass-stoppered bottles, in a cool and dark 
place. 

Dose, 2-15 minims (o. 1 2-1.0 Cc.) [5 minims (0.3 Cc. ), U. S. P.]. 

Official Preparations. 

Aqua Chloroformi — Aquae Chloroformi — Chloroform Water. — Dose, 1-4 
fluidrachms (4.0-16.0 Cc). 

Emulsum Chloroformi — Emulsi Chloroformi — Chloroform Emulsion. — 
Dose, 1-4 fluidrachms (4.0-16.0 Cc). 

Linimentum Chloroformi — Linimenti Chloroformi — Chloroform Liniment. 
— For external use. Chloroform, 30 ; soap liniment, 70 parts. 

Spiritus Chloroformi — Spiritus Chloroformi — Spirit of Chloroform. — Dose, 
10 minims-i fluidrachm (0.6-4.0 Cc). 

Physiological Action. — Externally and Locally. — Its action is 
similar to that of ether, though when confined on the skin it pro- 
duces vesication. It is more of an irritant to mucous membranes 
than ether, yet when inhaled it is less irritating to the respiratory- 
tract. 

Internally. — Digestive System. — Its action upon the digestive 
tract is nearly identical with that of ether, except that when taken 
in a concentrated form it occasions marked irritation of the stomach 
and intestines, often resulting in violent gastro-enteritis. 

Nervous System. — It affects the brain and spinal cord in the 
same manner and order as ether, like it producing death, usually by 
respiratory failure, though sometimes the heart first succumbs to 
the influence of the drug. 

Respiratory System. — Its action closely resembles that of ether, 
though its operation is more rapid and powerful. 



160 A TEXT-BOOK OF MATERIA MEDICA. 

Circulatory System. — Chloroform depresses the heart and circu- 
lation, the former by weakening the cardiac muscle, and the latter 
by lowering arterial pressure by depressing the vaso-motor center. 
It frequently produces an intermittent pulse by stimulating the 
inhibitory ganglia of the heart. 

Absorption and Elimination. — Chloroform affects the kidneys by 
irritation, certain investigators claiming that acute nephritis ensues, 
blood and albumin being often present ; it is certainly less irritating 
than ether. 

Temperature. — It depresses the temperature. 

Untoward Action. — If there be any marked idiosyncrasy against 
chloroform, death has been known to occur suddenly after a few 
inhalations of the drug. 

When applied externally there is produced not infrequently an 
urticaria-like eruption or an eczematous condition of the skin ; 
vesicles may result. If applied to sensitive portions of the skin, 
such as the scrotum, severe and persistent pain is sometimes occa- 
sioned. Frequently, when applied to wounds and mucous mem- 
branes, it causes intense irritation, so much so that the mucous 
membrane may be shed in pieces. 

The symptomatic manifestations of chloroform-anesthesia, the 
methods of administration, and the treatment of chloroform acci- 
dents are in the main similar in general principle to ether, and will 
be considered only in so far as certain differences are concerned. 

The appliances used* in producing anesthesia by the aid of 
chloroform are various, the simplest, as in the administration of 
ether, being a cone formed of a napkin or a towel enclosing a sponge 
or not, a sponge alone, or a handkerchief, upon which a small 
quantity of chloroform — not exceeding from a half to one fluid- 
drachm (2.0-4.0 Cc.) at a time — is poured. The utmost vigi- 
lance is requisite in the administration, the respiration, pulse, and 
facial indications being constantly observed; a supply of air is 
allowed to mingle with the anesthetic to obviate the dangerous 
effect of its concentrated vapor. The drug should be instantly 
withdrawn upon the slightest indication of untoward symptoms, 
such as lividity of the face, debility of heart-pulsation, and ster- 
torous or spasmodic respiration, and an ominous dilatation of the 
pupils. 

Although the symptomatic features of chloroform-narcosis, 
especially those which accompany collapse and death, have been 
studiously examined, the conditions causing disaster are still but 
imperfectly understood. Nevertheless, premonitory indications are 
seldom wanting which mark clearly enough the limit of safety in 
administration. Of these, extreme mydriasis and failure to pro- 
duce reflex action in the conjunctiva are alone symptoms to be 
ded with the gravest apprehension. 

Relative Safety. — Comparisons as to the relative safety of ether 
and chloroform are misleading. Statistics pointing in both directions 
have been compiled, and certain surgeons have distinct biases. It 



GENERAL ANESTHETICS. 161 

would appear that more untoward accidents occur under chloroform- 
anesthesia than under ether, and a fair estimate may be made of I 
death in 2500-3000 anesthetizations, while for ether observations 
of numerous surgical services show an average of 1 in 10,000- 
15,000. Gurlt's statistics on over 300,000 anesthesias resulted in 1 
in 2000 for chloroform to 1 in 5000 in ether. 

Some Points of Difference in Ether and Chloroform. 

Ether. — Not in tropics because of low Chloroform. — Tropics, 
boiling-point. 

Avoid flame. Not readily ignited. 

Large bulk. Army work. Small bulk. Army work. 

Local anesthetic. Cooling. Not adapted. Irritant. 

Irritant to glottis. Non-irritating. Children. 

Bronchitis. 

Longer time. More excitement. Shorter time. Less excite- 

ment. 

Larger quantity. 6 per cent, vapor. Small amounts. 1 per cent. 

vapor. 

Somewhat safer. Accidents more liable. 

Irritant to kidneys. Also irritant. Thought to 

be less. 

The comparative value of ether and chloroform may be sum- 
marized as follows : 

1. If an anesthetic be required, ether is preferable in the case of 
a patient suffering from a weak cardiac action or an organic disease 
of the heart. 

2. For operations about the face or of the stomach, as there is 
less danger of reflex inhibition of the heart, ether is preferable to 
chloroform. 

3. Ether is preferable as an anesthetic in the extraction of teeth, 
chloroform being more apt to cause cardiac paralysis, reflexly by 
way of the dental nerve to the root of the vagus, and through the 
vagus to the inhibitory ganglia of the heart-muscle. 

4. Ordinarily, ether is superior to and safer than chloroform as 
an anesthetic for adults unless some special contraindication exists, 
there being less danger in ether of cardiac failure, to which adults 
are more liable. 

The use of chloroform is more desirable under certain conditions, 
thus : 

1. Obstetrics, since the use of it is attended with less depression 
and irritation of the respiration and respiratory tract. Moreover, 
chloroform produces less nausea and vomiting, and may be admin- 
istered by the patient herself under proper directions. 

2. It is preferable in anesthetizing children, being more rapid in 
its action and less potent as a respiratory depressant, the respiratory 
center of the child being more- susceptible than that of the adult, 
and in children the danger of cardiac paralysis being slight. 

3. Should the patient be suffering from nephritis, chloroform is 
preferable as an anesthetic, since it is less irritating to the kidneys. 

4. Should an anesthetic be required for patients afflicted with 

11 



162 A TEXT-BOOK OF MATERIA MEDICA. 

pulmonary tuberculosis, empyema, or other disease of the lungs, 
chloroform should be used, since its effect upon the respiratory 
system is less depressing. 

5. It is preferable in very hot climates, as ether boils at 3 7° C. 
(98.6 R). 

^Ethylis Chloridum— ^Ethylis Chloridi— Ethyl 
Chloride. U. S. JP. 

Definition. — A haloid derivative prepared by the action of hydrochloric acid gas 
upon absolute ethyl alcohol. It is also known as chelene or kelene. 

Description. — A colorless, mobile, very volatile liquid, having a characteristic, 
rather agreeable odor and a burning taste. It boils at a temperature of 12.5 to 13 C. 
It is slightly soluble in water, readily in alcohol. It is very inflammable and should 
not be used in proximity to a gas flame or fire. 

A volatile, colorless, and inflammable liquid, having a pleasant 
odor. It is a very fugacious anesthetic, greatly depressing the 
heart and respiration, and is mainly used in the form of a spray, 
to produce local anesthesia. Caution should be observed in opera- 
tions about the head, as freezing of the cornea is apt to leave residual 
opacities. 

Additional Anesthetics and their Comparative Value. 

Ethyl Bromide. — A colorless, inflammable liquid, with a burn- 
ing taste and an odor like that of chloroform. It is readily decom- 
posed, with evolution of bromide. Its action is uncertain, causing 
great irritation of the respiratory passages, and usually producing 
death by paralysis of respiration. 

Ethyl Iodide. — A liquid anesthetic, similar in its physiological 
action to chloroform. Anesthesia produced by it, however, is more 
tardy, although more permanent. It is considered a comparatively 
safe and efficient anesthetic to relieve spasm of the respiratory pas- 
sages, as in asthma and laryngitis. 

Ethylene Bichloride. — More rapid and powerful in its action 
than chloroform, though not so safe, affecting the respiratory center 
invariably before influencing the heart. While speedier in its action 
than ether, it is probably more dangerous. 

Ethylene Bromide. — A weak yet dangerous anesthetic, greatly 
depressing the respiratory center, and tending to cause paralysis 
of the extremities and stoppage of the heart. 

Ethylene Iodide. — A crystalline substance, its fumes when 
heated producing anesthesia, with great irritation of the respiratory 
passages, and death by asphyxia. 

Ethylidene Chloride. — A non-inflammable liquid resembling 
chloroform in its physical appearance, and in its physiological action 
as well, although much less depressant to the heart. It causes 
more irritation to the respiratory passages, with vomiting and great 
languor and discomfort as its sequelae. 

Methyl Chloride. — A colorless, inflammable gas, with a taste 
and odor resembling those of ether and chloroform. Cold liquefies 



GENERAL ANESTHETICS. 163 

it. It is used locally to produce anesthesia and to relieve pain in 
neuralgia. 

Methylene Bichloride.— A colorless liquid, its odor being like 
that of chloroform. Exposure to the light decomposes it. Anes- 
thesia produced by this agent is accompanied with comparatively 
little irritation of the respiratory tract, but it occasions a primary 
stage of excitement like that induced by ether, and, as in the case 
of chloroform administration, vomiting is likely to ensue. Death 
takes place from paralysis of the heart. The numerous fatalities 
which have occurred under this anesthetic indicate the danger of 
its use, and its volatility renders its employment difficult in a hot 
atmosphere. 

Carbon Tetrachloride — -Tetrachlormethane. — A transparent, 
colorless liquid, of an agreeable aromatic flavor, analogous in its 
action to chloroform, but less irritating, although far more danger- 
ous to the heart. 

Formic Ether. — A thin, colorless, inflammable liquid, of strong, 
agreeable odor and pungent taste. It acts like chloroform, though 
the signs of asphyxia are less marked. Its effects last for several 
hours. 

Methylic Ether. — A colorless, inflammable gas, heavier than 
air, of an ethereal odor and aromatic taste. Richardson considers 
it a safe anesthetic, though objectionable because of its odor — less 
agreeable than those of ether and chloroform — and the rapidity with 
which it volatilizes from its solution. 

Methylal — Methylene — Dimethyl Ether. — A highly volatile, 
colorless, limpid liquid, of penetrating ethereal odor. It is used 
chiefly as a local anesthetic and as an efficient hypnotic in insanity 
and delirium tremens. 

Acetic Ether (U. S. P.). — A colorless, limpid, volatile liquid 
having an agreeable, refreshing, ethereal, and somewhat acetous 
odor and taste. It has the advantage over sulphuric ether of being 
less inflammable and less volatile. Owing to its pungent and 
agreeable odor, too, it is superior to the latter drug in stimulating 
the nasal passages in cases of syncope and nervous agitation. 

Pental. — A colorless, volatile, inflammable liquid, insoluble in 
water, but miscible in all proportions with alcohol, ether, and chlo- 
roform. It has a mustard-like odor, and is comparatively free from 
danger. When poisonous amounts are administered the pulse is 
quickened, the respiration embarrassed, and death ensues from 
paralysis of the heart. It resembles chloroform rather than ether, 
but is less irritating and seldom accompanied with unpleasant after- 
effects. It requires but about 5 drachms (20.0 Cc.) to produce 
anesthesia, which occurs in from two to three minutes. 

There is a difference of- opinion as to the safety of pental, some 
physicians considering it less dangerous than chloroform, and others 
regarding it as less efficient and not so safe. 

Nitrous Oxide (" Laughing- Gas "). — A colorless gas, of a very 
slight, agreeable odor and sweetish taste. It is not inflammable, 



164 A TEXT-BOOK OF MATERIA MEDICA. 

but supports combustion of ignited bodies. Pressure and cold con- 
dense it into either a thin, colorless, very mobile liquid or colorless 
crystals. It is a rapid anesthetic, unconsciousness being produced 
in from one-half a minute to three minutes. The pulse is strong 
and quick, the respirations frequent and shallow, while, as the 
inhalation continues, the breathing becomes stertorous and the face 
is cyanotic. If the inhalation be interrupted or the gas mixed with 
air, symptoms of intoxication are manifested, accompanied with a 
high degree of mental excitement. It is a very safe anesthetic, but 
the anesthesia is of quite short duration, rendering it valuable mainly 
for the extraction of teeth and in minor surgery. 



HYPNOTICS. 

The term hypnotics has been applied to a group of substances 
capable of inducing sleep. A large number of these hypnotics are 
members of the methane series, or close derivatives. Their hypnotic 
action is directly comparable with that of alcohol, ether, or chloro- 
form, but, by reason of the addition to the methane radical of different 
substances, other physiological actions may ensue which may 
modify to some extent the action of the primary substance. A 
number of hypnotics — bromides, cannabis, opium — have actions dis- 
tinct from the alcohol series of hypnotics. (For summary of these 
see p. 139.) 

As already intimated, practically the only alcohol used as a 
hypnotic is amylene hydrate. Its action resembles that of alcohol, 
but it induces narcosis more rapidly with smaller doses. 

Amylene Hydrate. 

A tertiary alcohol, the chemical name being dimelhyletkylcarbinol. 

Description and Properties. — It occurs as a limpid, colorless, neutral fluid, 
of a peculiar odor and burning taste. It is soluble in 8 parts of water, and miscible 
in all proportions with alcohol, chloroform, benzin, glycerin, and fixed oils. 

Dose. — 1-2 fluidrachms (4.O-8.O Cc). 

Therapeutics. — Amylene hydrate is a useful hypnotic, interme- 
diate in strength between paraldehyde and chloral. It is pleasanter 
to take than either. Many observers consider it to be safer than 
chloral, while its soporific effects are produced sooner, being mani- 
fested usually in from five to thirty minutes, the awakening being 
ordinarily prompt and complete. Amylene hydrate is best given in 
a mixture of wine and syrup of liquorice; if administered by rectum, 
it should be suspended in mucilage. 

Of the ethers, other than ethyl ether, mcthylal and acetal have 
both been tried. They have both been found to depress the heart 
action. Methylal is very rapidly eliminated, and the hypnosis 
induced is of very short duration. It is given in doses of 0.5-1 
(8-15 gr.), and is also useful as a carminative. 



HYPNOTICS. 165 

The esters that have been shown to be serviceable as hypnotics 

are urethane, hedonal, and veronal. 

v^Ethylis Carbamas— Ethyl Carbamate— Urethane. 

u. s. r. 

NH 
Definition.— An ester of carbamic acid, CO< QC |^ , obtained by the reaction of 

25 . NH 

ethyl alcohol upon urea (carbamide) or one of its salts. Reaction : CO<^£[ 2 + 

HOC 2 H 6 = CO<g*?| i6 + NH 3 . 

Description and Properties.— It occurs as colorless, odorless, columnar, or 
tabular crystals, having a pleasant, cooling, and saline taste, somewhat resembling that 
of saltpetre. It is soluble in about I part of water, and in like proportion in ether 
and chloroform, in 0.6 part of alcohol, 0.8 part of liquefied carbolic acid, 3 parts of 
glycerin, 15 parts of castor oil, and 20 parts of olive oil. 

Dose. — 10-45 grains (0.6-3.0 Gm. ) [15 grains (I Gm.), U. S. P.]. 

Its physiological action resembles others of the alcohol narcotics. 
The presence of (NH 2 ) groups prevents an overaction as a hypnotic, 
and in large doses may even destroy its sleep-producing effects, 
causing stimulation as in ammonia. It is less depressing upon the cir- 
culation and respiration than chloral, but more so upon the periph- 
eral ends of the motor nerves. Acting directly upon the cere- 
brum, it produces a refreshing and dreamless sleep, with no 
unpleasant after-effects. Nevertheless, it is not so reliable a hypnotic 
as chloral, and its usefulness as a therapeutic agent is still a 
debatable question, probably no hypnotic having been introduced 
concerning the effects of which there is such diversity of opinion. 
It may be given in capsules or in some pleasant water or syrup, 
and may also be conveniently administered as an injection by the 
rectum. 

Hedonal. 

NH 
Methyl-propyl-carbinol urethane, CO^p. 2 prrXH, 

Properties. — A white crystalline powder insoluble in cold water, slightly solu- 
ble in warm water. Soluble in alcohol. 

Dose. — From 15-45 grains (1-3 Gm.), best given dry on the tongue, washed 
down, or in a capsule or cachet. 

Therapeutics. — A useful hypnotic but not powerful, closely 
related to ethyl carbamate. Valuable in the insomnia of neu- 
rasthenia. It is markedly diuretic and hence may be useful in the 
insomnia of Bright's disease with diminished secretion. Large 
doses have been known to cause depression. 

Veronal. 

A related product. Diethyl-malonyl urea, C(C 2 H 5 ) 2 CO(CONH) 2 . 
Properties. — A white crystalline powder, soluble in 145 parts of cold water and 
12 parts of boiling water. Slightly bitterish taste. 
Dose. — 8-15 grains (0.5-1 Gm.). 

Therapeutics. — A valuable hypnotic of marked action and little 
after-effects in small doses, save some mild headache. Following large 



1 66 A TEXT-BOOK OF MATERIA MEDIC A. 

doses, considerable dizziness, and even delirium has been observed. 
Tolerance does not seem to be readily established. It is valuable 
in the insomnia of hemorrhage following childbirth, and is useful in 
mild maniacal excitement. The reports thus far published seem to 
indicate that it is reliable and safe. 

Of the aldehydes paraldehyde is the oldest and best known. 
With the vast accession of new and reliable hypnotics there is little 
occasion to give this disagreeable substance. It is safe, however. 
Sulphonal, trional, and tetronal are three newer hypnotics of this 
general chemical group. They are sulphons, methane hydrocar- 
bons synthetized with sulphur. 

Paraldehydum— Paraldehydi— Paraldehyde. 

U. S. P. 

Origin. — A polymer of acetaldehyde [CH 3 .COH]. 

Description and. Properties. — A colorless, transparent liquid, having a 
strong, characteristic, but not unpleasant, pungent odor, somewhat resembling that of 
chloroform, and a burning, cooling taste. Soluble in 8 parts of water at 25 C. 
(77° F.) and in 16.5 parts of hot water, being, as will be observed, more soluble in 
the former than in the latter. Miscible in all proportions with alcohol, ether, and fixed 
and volatile oils. 

Dose. — l X—i fluidrachm (1.0-4.0 Cc.) [30 minims (2 Cc), U. S. P.]. 

Physiological Action. — Externally and Locally. — Antiseptic, 
antifermentative. In general its action is like that of alcohol. 

Internally. — Digestive System. — Paraldehyde has little action 
upon the digestive tract. It may cause indigestion. 

Nervous System. — Its influence upon the brain and spinal cord 
is similar to that of chloral. The sleep it induces, however, is not 
so prolonged as that caused by the latter drug, more frequent doses 
being required for continued soporific effects. The sequelae of 
paraldehyde are not unpleasant. 

Circulatory System. — It differs from chloral in affecting the cir- 
culatory system favorably in medicinal doses, tending rather to 
slow and strengthen the pulse. Toxic doses weaken the heart and 
lower arterial pressure, the heart's action ceasing in diastole. 

Respiratory System. — Its action resembles that of alcohol, al- 
though it is not so powerful a respiratory depressant as the halogen 
derivatives of alcohol. In toxic doses death usually ensues from 
paralysis of the respiratory center. 

Absorption and Elimination. — Paraldehyde is eliminated by the 
lungs and kidneys. 

Temperature. — Like alcohol, it lowers the temperature, but in 
less degree. 

Untoward Action. — It occasionally causes irritation of the mucous 
membranes and erythematous eruptions. 

Poisoning. — The symptoms of poisoning are similar to those of 
chloral. Fatty degeneration of the heart and liver have been found, 
together with disorganization of the red corpuscles. 



HYPNOTICS. 167 

Treatment of Poisoning. — The same as in poisoning from chloral. 

Therapeutics. — Like those of chloral. Paraldehyde is more 
hypnotic than anodyne, appearing to be best adapted to relieve so- 
called idiopathic insomnia. It is a better diuretic than chloral, and 
in certain degenerated conditions of the heart and arteries, where a 
diuretic as well as hypnotic is desirable, paraldehyde serves as a 
valuable remedy. 

Administration. — It may be given in capsules, or, when other- 
wise administered, its unpleasant taste may be disguised by giving 
it in an emulsion flavored with orange or bitter almond. Glycerin 
also renders it quite palatable, yet it is always more disagreeable to 
the taste than chloral, besides lending to the breath an offensive 
and persistent odor. 

SULPHUR DERIVATIVES OF ALCOHOL. 

In a series of experiments on the feeding of animals with sul- 
phur compounds with reference to the formation of fat, Baumann 
and Kast found that several of the products caused sleep, and they 
investigated the whole series of sulphons. Disulphon itself they 
found inactive, and a large number of the simpler members of the 
group were found to be inactive because they were not broken up 
by the body. In those sulphons, however, with a large number of 
methyl or ethyl groups, they found marked oxidation in the body 
with a strong hypnotic action. Sulphonal (diethylsulphondi- 
methylmethane), trional (diethylsulphonmethylethylmethane), and 
tetronal (diethylsulphondiethylmethane) they found were the best 
of these, and they have been introduced into therapeutics with 
success. 

Sulphomethanum— Sulphomethane— Sulphonal. 

U. S. I>. 

CT-T SO C TT 

This substance, diethylsulphondimethylmethane, rH>C<oAVTT 5 , is the prod- 
uct of the oxidation of the mercaptol obtained by the condensation of acetone with 
ethylmercaptan. 

Description and Properties.— It occurs as colorless, odorless, nearly taste- 
less prismatic crystals ; soluble in 360 parts of cold water, in 15 parts of boiling water, 
and in 65 parts of cold or 2 parts of boiling alcohol. It is a very stable substance, 
being unaffected by concentrated acids or alkalies. 

Dose.— 15-30 grains (1.0-2.0 Gm. ) [15 grains (1 Gm.), U. S. P.]. 

Physiological Action. — Externally and locally, sulphonal has 
no influence. 

Internally. — Digestive System. — In medicinal doses it has no 
effect on the digestive tract. Toxic doses may result in nausea, 
vomiting, and gastric pain. 

Its action on the nervous system, on the circulation, and on res- 
piration is like that of alcohol. The sulphon radicals do not seem 
to enter into the cerebral action to any great extent. 

Absorption and Elimination. — Being relatively insoluble its absorp- 
tion is slow, usually requiring three to five hours to exert its hyp- 



1 68 A TEXT- BOOK OF MATERIA MEDIC A. 

notic action. It seems to be broken up in the body, only traces 
being eliminated unchanged. Traces of methylene and diethylene 
sulphonic acid appear in the urine. The sulphates of the urine 
have been said to be increased under its continued use, and in its 
passage through the blood it exerts a marked action on the red 
blood-cells, giving rise to a peculiar type of poisoning. 

The untoward actioji and poisoning resulting from the use of 
sulphonal present symptoms of so varied a character that the drug 
seems to possess no properties of a uniformly toxic nature. More- 
over, in the cases of poisoning recorded the condition of the patient and 
the quality of the drug have been such as to require considerable 
variation in the amount given. In one case 30 grains (2.0 Gm.) 
produced death in forty hours (Med. News, lv., p. 166); while in 
another a man swallowed 3 ounces (96.0 Gm., of sulphonal, which, 
although resulting in a condition of coma lasting six days, terminated 
in recovery [Jour. Amer. Med. Assn., iv., p. 21). 

In general, however, the poisonous effects of sulphonal are ex- 
erted on the blood and on the nervous system. When large doses 
are taken unconsciousness, which may persist for long intervals, is 
the most prominent symptom. Paralyses, but rarely convulsions, 
have been noted. Respiration is at first unaltered, but later may 
become stertorous, shallow, and slow. Cyanosis develops ; the 
pulse is small and irregular. A preliminary fall of temperature is 
followed by a rise, perhaps to 40 C. (104 F.). The kidneys may or 
may not be affected. There may be constipation, or, if paralysis of 
the intestinal musculature has occurred, a diarrhea may supervene. 
Papular exanthemata are not uncommon. 

In individuals who may be taking any of this type of hypnotics 
for any considerable period of time irregular toxic symptoms are 
noted. These consist for the most part of hebetude, sleepiness, 
stupidity, loss of appetite, and muscular weakness ; the frequency 
of the pulse is diminished, and if the poisoning is more pronounced, 
there may be dizziness, ataxia, and, rarely, hallucinations and delir- 
ium. The most important symptom is the presence of hematopor- 
phyrinuria, produced by the breaking up of the blood-pigment in the 
red corpuscles and its appearance in the urine as hematoporphyrin, 
a reduction product of hemoglobin. This gives this fluid a peculiar 
cherry-red color. Its appearance is a signal to cease the use of the 
drug. 

Of the three drugs of this class, trional is perhaps to be pre- 
ferred. Tetronal is not to be recommended. Very persistent 
habits may be contracted by takers of these drugs. 

Treatment of Poisoni)ig. — Discontinuance of the drug; elimina- 
tive and symptomatic treatment. 

Therapeutics. — Sulphonal is never used externally, and inter- 
nally it is valuable only as a hypnotic — in insomnia unaccompanied 
by pain, and particularly to produce sleep and quiet the intense ex- 
citement of the insane. 

Administration. — Sulphonal should be given in powder or cap- 



HYPNOTICS. 169 

sules or in hot whiskey. Owing to its insolubility, it should not 
be administered in the form of compressed tablets. 

Sulphonethylmethanum — Sulphonethylmethane — 
Trionai. V. S. JP. 

Diethylsulphonmethylethylmethane, (CH 3 )(C 2 H 5 )C(S0 2 C 2 H 5 ) 2 , a product of the 
oxidation of mercaptol, obtained by the condensation of methylethylketone with ethyl- 
mercaptan. 

Description. — It occurs in colorless, lustrous, odorless, crystalline scales which 
have a bitter taste in aqueous solution. Trionai is soluble in 195 parts of water, more 
readily in boiling water, and readily soluble in alcohol and ether. It melts at 76 C. ; 
hence if a test-tube containing some of the powder be placed in hot water, the sub- 
stance will melt ; sulphonmethanum sulphonal (the melting-point of which is 125.5 C.) 
will not melt under these circumstances. 

Dose. — Average dose, 15 grains (I Gm.), U. S. P. 

Therapeutics. — By reason of its greater solubility its action is 
more rapid than that of sulphonal. Identical symptoms of poison- 
ing as those of sulphonal have been noted, but breaking down more 
rapidly and being eliminated much faster, the tendency to cumula- 
tive action and to blood-destruction seems less than with its ally 
sulphonal. In combination they are useful hypnotics. 

Tetronal (Diethyl-sulphon-diethyl-methane). — Origin. — This substance is 
also prepared like sulphonal. 

Description and Properties. — Colorless, shining plates and laminae, of bitter taste 
and slightly camphoraceous odor ; soluble in 450 parts of cold and in 5 parts of boil- 
ing alcohol ; insoluble in water. 

Dose. — 10-40 grains (0.6-2.5 Gm. ). 

Therapeutics. — Tetronal seems to be more poisonous than either 
of the others of the group. Why this should be so is not yet estab- 
lished. Like sulphonal, however, it breaks down slowly, and a 
cumulative action may account for its greater toxicity. 

HALOGEN DERIVATIVES OF ALCOHOL. 

A large and important series of hypnotics are classed in this 
group. Chloral, the point of departure of the others, has been in 
use for a number of years, and in the attempt to produce a similar 
body free from the disagreeable taste and from some of the more 
depressing cardiac action, a host of alcohol halogens has been 
made and introduced into therapeutics. 

The introduction of chlorine into the hydrocarbon series produces 
a more marked change in the action than has been noted for many 
of the alcoholic derivatives already discussed. 

Ordinary marsh gas, CH 4 , has a very slight narcotic action. 
CH3CI is stronger, CH 2 C1 2 still stronger, CHC1 3 (chloroform) very 
active, and CC1 4 very highly toxic. A gradual increase in tox- 
icity has been observed with the addition of chlorine atoms. In 
the same manner aldehyde is a mild narcotic, trichloraldehyde 
much more powerful. A large number of these compounds have 
been employed in anesthesia ; these have already been discussed. 

For the most part the newer chloral substitutes are known to 



170 A TEXT-BOOK OF MATERIA MEDICA. 

break down into chloral in the metabolism of the body. On 
general principles, therefore, it is difficult to see wherein they are to 
offer any marked advantages over the parent body itself. If, how- 
ever, the compound with which it is combined is so split off in the 
body and is then so unmodified as to be active and to be able to 
overcome the untoward effects of the chloral or its reduction com- 
pounds, a useful hypnotic must be the result. Up to the present 
time it does not appear from other sources than those with a com- 
mercial bias that this very desirable combination has been found. 
There is no reason to believe that it may not be accomplished, but 
nearly all the theoretically possible combinations have been made 
and tried. A number of the compounds now manufactured are 
useful nevertheless, and will be here considered. 

Chloralum Hydratum— Chlorali Hyd rat i— Hyd rated 
Chloral. 77. S. JP. 

Definition. — A crystalline solid composed of trichloraldehyde or chloral 
[CCl 3 .COH] (an unstable, oily, and colorless fluid), with I molecule of water, forming 
the Hydrate of Chloral, the official preparation, and the only one used in medicine. 
Ch'.oral itself is prepared by the action of chlorine upon alcohol, whence the name 
chlor-al. 

Description and Properties. — Chloral hydrate occurs as separate, rhom- 
boidal, colorless, transparent crystals, having; an aromatic, penetrating, and slightly 
acrid odor, and a bitterish, caustic taste. It is slightly volatilized when exposed to the 
air, and is freely soluble in water, alcohol, and ether, being also soluble in chloroform, 
benzol, benzin, carbon disulphide, and fixed and volatile oils. It liquefies when tritu- 
rated with an equal quantity of camphor, menthol, thymol, or phenol. 

Dose. — 5-20 grains (0.3-1.2 Gm.) [1 G121.-15 gr., U. S. P.]. 

Physiological Action. — Externally and Locally. — Chloral is 
antiseptic, anesthetic, and vesicant. It produces redness and some- 
times vesication when applied to the unbroken skin, and when 
strong solutions are brought in contact with the derma or with 
wounds they may even occasion sloughing, and in healthy mucous 
membranes excite much pain. When introduced into the system 
hypodermically chloral is apt to occasion gangrenous inflammation. 

Internally. — Digestive System. — Small doses are slightly seda- 
tive to the stomach, though causing a sense of burning in the 
throat and exciting more or less salivation. Large doses some- 
times produce nausea, vomiting, and purging. 

Nervous System. — Medicinal doses sometimes occasion a pre- 
liminary stage of cerebral excitement, due probably to a tempo- 
rary stimulation of the circulation and possibly transitory cortical 
irritation. This is soon followed — usually in from fifteen to thirty 
minutes — by a sound, dreamless slumber, induced by a direct 
depression of the cortical cells of the brain. The sleep thus pro- 
duced closely resembles that of physiological slumber. It usually 
persists for from seven to eight hours, when the patient awakes 
refreshed and without malaise or digestive disturbance. 

The action on the spinal cord is one of depression, as in alcohol. 
The actions on the special senses resemble those of chloroform. 



HYPNOTICS. 171 

Respiratory System. — In full doses chloral is a respiratory 
depressant, rendering the breathing slower and weaker, while 
under toxic doses it may cease altogether from paralysis of the 
respiratory center. 

Circulatory System. — Full medicinal doses may at first accel- 
erate the pulse, which soon, however, becomes slower, weaker, and 
softer. Under toxic doses the heart's action may be weak, rapid, 
and irregular, when death ensues, the heart being arrested in 
diastole. 

A primary effect of chloral is to lower arterial tension by its 
depressant action upon the heart through its nervous mechanism. 
It acts similarly upon the vasomotor center and upon the struct- 
ures in the arteriole wall, dilating the blood-vessels. 

In its depressing action on the heart chloral is more pronounced 
than in other non-chlorinated members of the alcohol group. It 
is highly probable that the presence of chlorine is an important 
factor in this added toxic action in the circulation. 

Absorption and Elimination. — Chloral is quite rapidly absorbed, 
and is supposed to circulate in the blood in its original state. It is 
eliminated by the lungs and skin, but chiefly by the kidneys, where 
it reappears as urochloralic acid, which consists of trichlorethyl 
alcohol combined with glycuronic acid, although when an excess- 
ive amount of the drug has been taken it may be found in the 
urine unchanged. It usually increases the flow of urine, and re- 
duces Fehling's solution. The presence of chloral derivatives 
should, therefore, always be thought of in testing for sugar. 

Metabolism. — Chloral behaves in large part as chloroform on 
metabolism. It leads to increased proteid destruction and lessens 
cellular oxidative functions. It thus shows increased phosphates, 
nitrates, and sulphur, and by the suboxidations leads as from alcohol, 
to fatty degenerations. The diminution in muscular activity re- 
tards muscle metabolism, thus less oxygen is observed and less 
carbon dioxide is excreted. In large doses chloral exerts a destruc- 
tive influence on the blood and also in blood-vessels. 

Temperature. — Chloral is a decided antipyretic even in medicinal 
doses, while toxic doses produce a dangerous reduction of tempera- 
ture. This action is doubtless owing to a diminution of heat-pro- 
duction because of diminished oxidation in the cells of the body 
and to an increase of heat-dissipation from the dilated cutaneous 
vessels. 

Untoward Action. — There may occur great anxiety ; disturb- 
ances of respiration, such as spasmodic breathing and even as- 
phyxia, together with disturbances of vision and swelling of the 
conjunctivae. There may also be present edema of the epiglottis, 
icterus, and various cutaneous eruptions commonly designated as 
" chloral rash." 

Poisoning. — Although one of the most powerful hypnotics 
known, extraordinary doses of chloral have failed to prove fatal, 
as many as 460 grains (30 Gm.) having been given without serious 



172 A TEXT-BOOK OF MATERIA MEDICA. 

poisoning. Nevertheless, 10 grains (1.6 Gm.), an ordinary dose, 
has been followed by toxic effects, while 15 grains (1.0 Gm.) has 
produced death. In view of so uncertain a power, great care is 
requisite in the administration of this drug. 

Acute Poisoning. — The symptoms of poisoning from lethal doses 
are those of profound alcoholic narcosis plus the specific chlorine 
action. The patient is comatose. The pulse is feeble, thready, and 
irregular ; the temperature is below normal ; respiration is slow ; 
the skin, particularly that of the forehead and extremities, may be 
covered with cold sweat and is pallid or cyanotic ; the pupil is 
moderately contracted. There is great muscular relaxation, to- 
gether with abolition of reflexes. Death is caused by paralysis of 
the respiratory center with pronounced cardiac weakness. 

Autopsies have revealed inflammation of the mucosa of the 
mouth, esophagus, and stomach. In the latter organ ecchymoses 
may be present. Blood-changes are not constant but agglutina- 
tion of the red blood-cells occur, and hyaline thromboses are pres- 
ent. Beginning fatty degeneration is also present in many of the 
organs, particularly the liver and kidneys. 

Treatment of Poisoning. — It is of primary importance to main- 
tain or restore the temperature by means of artificial heat — warm 
blankets, hot bottles, friction, massage, or other resources at com- 
mand. 

In order to arrest respiratory failure and stimulate the circula- 
tion, hypodermic injections of strychnine or atropine or the admin- 
istration of other physiological antidotes, the inhalation of oxygen, 
and artificial respiration, may prove advantageous. Coffee as a hot 
rectal infusion is of value, and intravenous salt infusion may be 
demanded in severe cases. Naturally all alcoholic forms of stimu- 
lation are to be avoided. 

Chronic Poisoning. — Chloral toxemia, or chloralism, is a well- 
recognized development of simple dosage. 

The skin as in alcoholism may be subject to erythematous 
eruption, either persistent or temporarily excited by trivial causes. 
Respiration is embarrassed by the presence of dyspnea, which, 
however slight, is manifested after meals or is stimulated by physical 
exertion. Finally, the gravest complications may occur in the 
circulatory system, resulting in high fever, pyemia, and ultimate 
collapse. 

The simplest treatment in these extreme cases is primarily the 
gradual withdrawal of the toxic agent, although delirium tremens 
is recorded as a result of abstention. The diet should be carefully 
regulated with a view to restoring, if possible, the decreased vitality. 
Change of scene, abundant air and exercise, chalybeate tonics, 
calmatives, and nerve-stimulants undoubtedly contribute to re-es- 
tablish functional activity and normal circulation, and occasional 
purgatives may assist in eliminating from the body the toxic elements 
which the pathological cells are constantly forming. 

Antagonists and Incompatibles. — Chloral is incompatible with 



HYPNOTICS. 173 

all alkalies, and calcic hydrate converts it into formate of calcium 
and chloroform. 

Synergists. — All the hypnotics favor its characteristic property 
of producing sleep. Morphine enhances its hypnotic effects, while 
lessening its depressing influence upon the heart. 

Therapeutics. — Externally and Locally. — An injection of a 10 
per cent, solution of chloral into the sac has been highly recom- 
mended by Marc See in the treatment of hydrocele. One ounce of 
this solution is injected, being followed in two or three days by a 
copious effusion, which is soon absorbed. 

The antiseptic properties of chloral are utilized as a wash or 
dressing in cancer of the uterus ; foul 'ulcers, etc. For these purposes 
the strength should be from 5 to 10 grains (0.3 to 0.6 Gm.) to 1 
ounce (30.0 Cc). 

Spohn recommends the continued application of a solution of 1 
drachm (4.0 Gm.) of chloral in 4 drachms (16.0 Cc), each, of 
glycerin and water in cases of furuncle. 

Bromidrosis and hyperidrosis have yielded to local applications 
of from 2 to 5 per cent, aqueous solutions of chloral. 

Camphorated chloral is often an efficient remedy for toothache, 
and, when mixed with petrolatum or simple ointment in the pro- 
portion of 1 to 7, makes an excellent application in pruritus and 
other itching diseases where the skin is unbroken. This prepara- 
tion undiluted has been used in neuralgia, painted over the affected 
nerves. 

Cregny employs a 20 per cent, solution of chloral in anal fis- 
sure, and a 1 per cent, solution is used in cracked nipples. 

Chloral is frequently used to preserve urine for microscopical 
examination, though it should not be added to urine reserved for 
chemical analysis intended to detect the supposed presence of sugar. 

Solutions of chloral are used for embalming purposes and the 
preservation of anatomical specimens. 

Internally. — The principal use of chloral internally is to depress 
the psychic mechanism and produce sleep. It is also employed to 
depress the reflexes and motor apparatus, and thereby diminish 
convulsions, and is sometimes useful in diminishing the activities 
of the sensory nerves. 

As a hypnotic it is especially valuable in conditions character- 
ized by excessive cerebral activity, such as insomnia resulting from 
overwork or worry, and in the wakefulness of many acute diseases 
— typhoid, typhus, and other fevers, delirium tremens, and puerperal 
mania — it is a remedy of well-known efficacy. Its depressing 
effects should always be guarded against during the active course 
of disease, as well as in delirium tremens where great cardiac weak- 
ness already exists. The insomnia of convalescence would usually 
indicate its use. 

On account of its powerful depression upon the motor mechan- 
ism it is a valuable drug in treating the various convulsions and 



1/4 A TEXT-BOOK OF MATERIA MEDICA. 

spasmodic disorders of childhood, such as whooping cough, laryn- 
gismus stridulus, status epilepticus, and myoclonus. 

In astlima, tetanus, uremic convulsions, hiccough, strychnine- 
poisoning, and hysteria chloral has proved a useful remedy. 

Chloral is useful in relieving the pains of carcinoma of the 
stomach ; it is extremely valuable in restraining chordee, and in 
painful contractions of hollow viscera it is valuable, as in colic, in 
gall-stone, in cystitis, etc. 

Certain forms of epilepsy, particularly the nocturnal variety, are 
benefited by this drug, and it has been found useful in angina pec- 
toris, though it should be very cautiously administered in these 
cases if there be reason to suspect valvular disease or degeneration 
of the cardiac muscle. 

The reflex vomiting in pregnancy is sometimes relieved by either 
the internal administration of chloral or by enemas. It has also 
been used to depress the reflexes in sea-sickness. 

It has given excellent results, used in rectal enemata, in the 
treatment of puerperal eclampsia. 

Spasmodic rigidity of the os uteri is greatly reduced by a medicinal 
dose of this remedy, and, while its action on the sensory mechanism 
is feeble, it is nevertheless frequently efficient in modifying the pains 
of labor and in quieting the alarm and allaying the nervous excite- 
ment of the mother. 

There are certain other pains of moderate intensity, especially 
those of neuralgia, which are temporarily more or less relieved by 
chloral. Its anodyne effect, however, is too transient to render 
chloral very popular as an analgesic. 

A combination of morphine and chloral is a very efficient ano- 
dyne and hypnotic in sleeplessness due to pain, which is palliated 
by this combination with less digestive disturbance than if the 
former drug had been used alone, and less cardiac depression than 
if the latter had been the sole remedy, the medicines thus aiding 
each other and serving the twofold purposes of mitigating pain and 
inducing sleep. 

In sthenic fevers chloral is an admirable remedy, not only as an 
antipyretic, but in allaying nervous irritability, restlessness, and 
excessive cardiac action. It dilates the blood-vessels, causes dia- 
phoresis, and sleep is often of great service. 

Contraindications. — Fatty heart ; marked respiratoiy weakness, 
whether due to acute or chronic diseases of the lungs ; atheromat- 
ous degeneration of the blood-vessels. 

The drug should be administered cautiously, the patient being 
uninformed as to its nature in certain nervous diseases, lest he 
acquire the chloral habit. 

Administration. — As is recommended in the case of all drugs, 
only the purest article should be prescribed. Frequently the un- 
toward symptoms of chloral are due more to the impure article 
than to any idiosyncrasy against it. The recrystallized form alone 
should be used, the first dose administered not exceeding from 15 



HYPNOTICS. 175 

to 20 grains (1.0 to 1.2 Gm.), repeated as occasion may demand. 
Ordinarily a maximum dose should not be given oftener than once 
in forty-eight hours. 

Children bear chloral well, and, as a rule, 1 grain (0.06 Gm.) may 
be prescribed for each year of the child's age. 

Enemas of chloral may be rendered less irritating by mixing 
the drug with the yolk of an egg and milk. Chloral should always 
be well diluted when given internally, especially when combined 
with sodium or potassium bromide. Its disagreeable taste may be 
partially disguised by mixing the solution with peppermint water and 
elixir or syrup of orange. 

Chloralformamidum— Chloralis Formamidati— 
Chloral Formamide. U. 8. P. 

(Chloralamide. ) 

Definition.— A crystalline solid [CC1 3 .CH(0H)NH.C0H] made by the direct 
union of formamide and anhydrous chloral. 

Description and Properties. — Chloralamide occurs as colorless, shining, 
odorless crystals, having a faintly bitter taste. It is soluble in 18.7 parts of water and 
in 1.3 parts of alcohol. Readily soluble in glycerin, ether, acetone, and acetic ether. 

Dose. — 10-30 grains (0.65-2.0 Gm. ). 

Physiological Action. — Chloralamide differs in no particular 
regard from chloral. It was hoped that the introduction of forma- 
mide might diminish the depressing action on the heart, but as 
chloral is split off in the body the resulting action is not modified, 
save for the slowness of action and necessarily larger dose. The 
formamide does not contribute to the action of the compound. 

Therapeutics. — It is not employed externally and locally. Its 
therapeutic uses are similar to those of chloral. As a hypnotic it 
is said by some observers to be superior when there is cardiac or 
respiratory weakness. Robinson l has not found it free from car- 
diac depressing qualities. It is much pleasanter to take than chloral. 
In the insomnia of neurasthenia it is especially valuable, and, in con- 
junction with potassium bromide, is preferable to a like combination 
with chloral in cases of seasickness. 

Administration. — It is best given in aromatic elixir or some 
other dilute alcoholic vehicle. Simple syrup slightly acidulated 
with hydrochloric acid, beer, and sweet wine are also recommended 
as pleasant menstrua. When given at night for insomnia the medi- 
cine should be taken upon an empty stomach, about one hour 
before sleeping-time. 

Unofficial Chloral Allies. 

Croton -chloral (Unofficial). — Origin. — Prepared by passing dry chlorine gas into 
acetic aldehyde, resulting in the formation of butyl-chloral, which is separated by 
fractional distillation, and water added. 

Description and Properties — Butyl-chloral occurs as a heavy, colorless oil, having 

1 Dent. med. Woch., 1889, No, 49. 



176 A TEXT-BOOK OF MATERIA MEDIC A. 

an odor resembling that of cnloral. The hydrate (croton-chloral hydrate) used in 
medicine is in the form of white scales, of a siiky luster, nauseous taste, and a pecu- 
liar fruit-like odor. It is freely soluble in alcohol, ether, glycerin, and hot water, 
but not easily soluble in cold water. Its solutions are unstable, and are decomposed 
if kept on hand even lor a short time. 

Dose. — 3-20 grains (0.18— 1. 2 Gm. ). 

Inconipatibles and Synergists are the same as for chloral. 

Its physiological action and therapeutics are quite similar to those of chloral. It 
was at one time thought that its analgesic properties were more pronounced than 
chloral and was highly recommended in facial neuralgia. For the severe cases it is 
worthless, and for the milder cases other analgesics are far better. It has now little 
practical use. 

Chloral-ammcnium. — Obtained by passing a rapid current of dry ammonia 
through a solution of anhydrous chloral and chloroform as long as it is absorbed. Its 
chemical name is trichloramidethylic alcohol. It occurs as small, white acicular crys- 
tals, and is soluble in alcohol and slightly soluble in water, although the aqueous solu- 
tion is unstable. 

Dose. — 15-30 grains (1.0-2.0 Gm.). 

It has no advantages over chloral. 

Chloralose. — Prepared by heating equal quantities of anhydrous chloral and dry 
glucose ; hence the name, chloral-ose. 

Description and Properties. — It occurs in the form of fine needles, completely vola- 
tilizing without decomposition. It has an acrid, nauseous taste, and is soluble in hot 
water and in alcohol. 

Dose. — 2—10 grains (o. 1 2-0.6 Gm.). 

Chloralose has been found to be more depressing than chloral. 

Hypnal. — A compound of chloral and antipyrine, known as monochlorantipyrine. 
A similar preparation containing more chloral is called dichloralantipyrine. 

Description and Properties. — It occurs in the form of transparent, rhombic crystals, 
odorless and tasteless, soluble in from 5 to 6 parts of water. 

Dose. — 5-20 grains (0.35-1.3 Gm. ). 

The addition of the antipyrine to increase analgesia, while hypothetically good, has 
not proven of service. 

Ural — Chloral-urethane — Uralium. — A compound of urethane and chloral 
hydrate. 

Description and Properties. — A crystalline body, soluble in alcohol and ether, in- 
soluble in cold water, and decomposed by boiling water. 

Chloretone — acetone chloroform — is the trade name of an old chemical com- 
pound, trichlopseudo butylalcohol. 

Description and Properties. — It is a white, crystalline substance, sparingly soluble 
in cold water, but freely soluble in hot water, ether, alcohol, and chloroform. It has a 
camphoraceous odor and a not unpleasant taste. 

Dose. 5-10 grains (0.30-0.60 Gm.) or even double this dosage. Best administered 

in powders or in alcoholic menstruum. 

This is undoubtedly a useful hypnotic with an action very similar to that of chloral, 
but if the recent studies of Impens are to be trusted, it is 2]/ 2 times as poisonous as 
chloral. Chloretone is an excellent antiseptic as well as a hypnotic and has been 
widely used as a dusting-powder for wounds. It has also been employed in the eye 
and is a marked local anesthetic. Poisonous local effects are reported, however- 
intense local edema, etc. 

Isopral is a closely related compound (trichloriso propyl alcohol). 

Hypnone.— As a hypnotic n much weaker substance than chloral, although it has 
found some advocates as a remedy for the insomnia of alcoholism. Toxic doses para- 
lyze the heart and respiration. It should be given in capsules. 

Acetonum— Acetoni— Acetone. T7. S. P. 

Definition.— A liquid containing not less than 99 per cent, by weight of absolute 
acetone. (U. S. P. | 

A etone is chemically dimethyl-ketone(CH 8 COCH 8 ). It is present to a consider- 
able extent in (rude wood alcohol. 

Description and Properties.— It is a clear, colorless, mobile, neutral liquid, 



HYPNOTICS. 177 

inflammable, and having an ethereal odor and taste. Specific gravity, 0,790 (25 C.) ; 
boiling-point, 56.5 C. It is miscible with water and alcohol in all proportions, and is 
an excellent solvent for fats, resins, rubber, etc. Iodoform is formed when acetone is 
slightly warmed with an alkali and iodine (basis of method for determining acetone in 
diabetic urine). Acetone is used widely in the manufacture of chloroform, iodoform, 
and sulphonal. A number of oleoresins (aspidium, capsicum, ginger, lupulin, and 
pepper) formerly prepared (U. S. P. 1890) with ether are now prepared with acetone. 



Physiological Action. — Acetone resembles ethyl alcohol in its 
action. It is more potent than ordinary alcohol, as a rule. This 
may be due to delayed elimination, as is the case in wood-alcohol 
poisoning, which latter, volume for volume, is less poisonous than 
ethyl alcohol, but being eliminated more slowly becomes practically 
more poisonous. 

Related Compounds. — When a phenyl radical (C 6 H 5 ) takes the 
place of one of the methyl groups in acetone, the resulting com- 
pounds is phenyl-methyl-ketone (C 6 H 5 COCH 3 ), also known as ace- 
tophenone. This has been used as a hypnotic under the name of 
Hypnone. It is a liquid above 20. 5 ° C. Malarine is a condensa- 
tion product of acetophenone and paraphenetidin. It is usually 
employed in the form of the citrate. 

Salacetolum is a salicylic acid ester of acetol, which is an alcohol 
(CH 3 COCH 2 OH) derived from acetone; proposed as an antirheu- 
matic. 

Aceto-acetic acid, also called diacetic acid (CH 3 COCH 2 COOH), 
or acetone in which a hydrogen atom has been replaced by (COOH), 
is found in the urine of many patients suffering from diabetes mel- 
litus. This acetone is thought to be a decomposition product of 
diacetic acid. 

Opium— Opii— Opium. U. S. JP. 

Definition. — The concrete, milky exudation obtained by incising the unripe cap- 
sules of Papaver somniferum (L.), and yielding in its normal moist condition not less 
than 9 per cent, of crystallized morphine when assayed. 

The poppy from which opium is derived is indigenous in Western Asia and culti- 
vated in Egypt, Persia, Asia Minor, the elevated plains of India, and in some parts of 
Europe. 

Description and Properties. — Opium appears in irregular or subglobular 
cakes — with the remnants of poppy-leaves and the fruit of a species of Rum ex adhe- 
ring to their surfaces — plastic or of a harder consistence, chestnut-brown or darker, and 
somewhat shining internally, showing tears, and fragments of vegetable tissue. It has 
a sharp, narcotic odor and a peculiar, bitter taste. This description applies to the 
Smyrna, Levant, Turkey, and Constantinople opium. There are, however, a number 
of other varieties— viz. : 1. Egyptian, flattened, roundish cakes; 2. Persian, black, 
cylindrical sticks, or small cakes or balls, wrapped in paper; 3. Indian, flat squares 
covered with mica and wax or an oiled-paper wrapper ; 4. Chinese, oblate-spheroidal 
masses wrapped in white paper ; 5. European. 

Opium contains about twenty different alkaloids, either in a free state or in combi- 
nation with some acids. The principal alkaloids, in the order of their medical im- 
portance, are morphine, codeine, narceine, and thebaine ; others are narcotine, papa- 
verine, cryptopine, pseudomorphine, protopine, hydrocotarnine, laudanine, cadamine, 
rheadim, ?neconidine, landanosine, lanthopine, gnoscopine, and oxynarcntine. 

The following constituents of opium are in some respects important : Meconic acid, 
meconin, meconoiosin, and porphvroxin. 

In addition to the above, opium contains these substances, making it one of the 
most complex drugs in materia medica : Mucilage, resin, fats, essential oil, glucose, 
12 



178 A TEXT-BOOK OF MATERIA MEDICA. 

caoutchouc, ammonium, calcium, and magnesium salts, and odorous and coloring-matters, 
besides certaing impurities and adulterants, such as stones, fruits, leaves, starch, water, 
lead, etc. 

The total amount of active alkaloids in opium may vary from 5-28 per cent., varia- 
tions in morphine alone showing from cipher to 22 per cent. As opium containing 
less than 9 per cent, morphine is supposed not to enter the United States, the average 
of most samples obtained is about 10 per cent., but in the smoking extract lower grades 
are employed ; the Smyrna and Patna varieties ; these frequently contain only 2-4 per 
cent, of morphine. 

Dose. — %-2 grains (0.015-0.12 Gm.) [i}4 grains (0.1 Gm.), U. S. P.]. 

The percentage of other alkaloids varies greatly, narcotine which 
occurs in amounts of from 1-8 per cent, is practically the only other 
alkaloid of moment. 

As to the chemistry of morphine itself, the structural formula is 
still undecided. It is probably an oxazone of the quinolene series 
and the following structural formula has been suggested: 




In apomorphine H 2 is removed from the second closed cycle, 
while in codeine a methyl CH 3 replaces the hydrogen in the upper 
right-hand closed cycle. 

Official Preparatiojis. 

Opii Pulvis— Opii Pulveris— Powdered Opium. — Dose, %-2 grains (0.015- 
0.12 Gm.) [1 grain (.065 Gm.), U. S. P.]. 

Powdered opium should yield not less than 12 nor more than 12.5 percent, of 
crystallized morphine. 

Acetum Opii (10 per cent.)— Aceti Opii— Vinegar of Opium.— Dose, 3-15 
minims (o. 18-1.0 Cc). 

Extractum Opii (20 per cent, of morphine) — Extracti Opii — Extract of Opium. 
— Dose, l /e-i grain (0.0 1-0.06 Gm.). 

Emplastrum Opii (6 per cent, of extract of opium) — Emplastrum (ace.) Opii 
— Opium Plaster. — For external use. 

Formula : Fxtract of opium, 60 ; Burgundy pitch, 180 ; lead plaster, 780 ; water, 80. 

Opium Deodoratum (12 to 12.5 per cent, of morphine) — Opii Deodorati — 
Deodorized Opium (DENARCOTIZED Opium). — Dose, ]^-2 grains (0.015-0.12 Gm.). 

Opium Granulatum (12 to 1 2. 5 per cent, of crystallized morphine). Dose, I grain 
(.065 Gm. I, U. S. P. Now used for making tr. opii instead of using the opii pulvis. 

Pilulae Opii (1 grain, or 0.065 Gm., in each pill)— Pilulas (ace.) Opii— Pills of 
Opium. — Dose, I or 2 pills. 

Pulvis Ipecacuanhse et Opii— Pulvis Ipecacuanhae et Opii — Powder of 
Ipecac and Opium (DOVER'S POWDER). — Dose, 5-10 grains (0.3-0.6 Gm.). 

Formula : 1 grain (0.06 Gm.") opium. 1 grain (0.06 Gm.) ipecac, 8 grains (0.5 Gm.) 
sugar of milk, in every 10 grains (0.6 Gm.). 



HYPNOTICS. 179 

Tinctura Opii (10 per cent.)— Tincturae Opii — Tincture of Opium (Lauda- 
num). — Dose, 5-15 minims (0.3-1.0 Cc.). 

13 minims (0.78 Cc.) represent about I grain (0.06 Gm. ) of opium. 

Tinctura Opii Camphorata — Tincturse Opii Camphoratae — Camphorated 
Tincture of Opium (Paregoric). — Dose, )/ z -\ fluidrachms (2.0-15.0 Cc). 

Formula: Powdered opium, 4 ; benzoic acid, 4; camphor, 4; oil of anise, 4; 
glycerin, 40 ; diluted alcohol, to 1000. Prepared by maceration and percolation. 
4 fluidrachms (15.0 Cc.) represent about I grain (0.06 Gm.) of opium. 

Tinctura Opii Deodorati (10 per cent.) — Tincturae Opii Deodorati — Tincture 
of Deodorized Opium.— Dose, 5-15 minims (0.3-1.0 Cc). 

Tinctura Ipecacuanhas et Opii — Tincturae Ipecacuanhae et Opii — Tincture 
of Ipecac and Opium (Tincture of Dover's Powder).— Dose, 5-15 minims 
(0.3-1.0 Cc). 

10 minims (0.6 Cc.) contain I grain (0.06 Gm.) each of opium and ipecac 

Trochisci Glycyrrhizae et Opii— Trochiscos (ace) Glycyrrhizae et Opii— 
Troches of Liquorice and Opium. — Dose, 1 to 3 troches. 

Each troche contains about ^ grain (0.005 Gm.) of opium. 

Vinum Opii (10 per cent.)— Vini Opii — Wine of Opium.— Dose, 5-15 minims 
(0.3-1.0 Cc). 

The description and properties of the official alkaloids of opium and their salts are 
as follows : 

Morphina — Morphinae— Morphine. — Colorless or white, shining, prismatic crys- 
tals, or fine needles, or a crystalline powder, odorless, having a bitter taste, permanent 
in the air. Soluble in 3330 parts of water, in 168 parts of alcohol, in 1040 parts of 
water at 8o° C, and in 36 parts of boiling alcohol. It melts at 254 C. Dose, %-% 
grain (0.008-0.015 Gm. ) [| grain (0.1 Gm.), U. S. P.]. 

Morphinae Acetas — Morphinae Acetatis — Morphine Acetate. — A white or 
faintly yellowish-white, crystalline or amorphous powder, having a faint, acetous odor 
and a bitter taste. Soluble in 2.5 parts of water and in 21.6 parts of alcohol. On pro- 
tracted exposure to the air the salt gradually loses some acetic acid, becoming less 
soluble. It should be kept in dark amber-colored, well-stoppered bottles. Dose, \-\ 
grain (0.008-0.015 Gm.). 

Morphinae Hydrochloridum — Morphinae Hydrochloridi — Morphine Hydro- 
chlorate. — White, feathery needles, of a silky luster, or minute, colorless, cubical 
crystals, odorless, having a bitter taste, permanent in the air. Soluble in 17. 2 parts of 
water and in 42 parts of alcohol at 25 C. Dose, \-\ grain (0.008-0.015 Gm.). 

Morphinae Sulphas — Morphinae Sulphatis — Morphine Sulphate. — White, 
feathery, acicular crystals, of a silky luster or in cubical masses, odorless, of a bitter 
taste, permanent in air. Soluble in 15.3 parts of water and in 465 parts of alcohol at 
25°C. Dose, \-\ grain (0.008-0.015 Gm. ). 

Codeina — Codeinae — Codeine. — White or nearly translucent, orthorhombic 
prisms, or octahedral crystals, or a crystalline powder, odorless, having a faintly bitter 
taste, and slightly efflorescent in warm air. Soluble in 88 parts of water and in 1.6 
parts of alcohol at 25 C. Dose, ^—2 grains (0.03-0.12 Gm.). 

Codeinae Phosphas — Codeinae Phosphatis — Codeine Phosphate. — Fine 
white crystals. Bitter taste. Soluble in 2.25 parts of water and 261 parts of alcohol 
at 25°C. Dose, % grain (0.03 Gm. ), U. S. P. 

Codeinae Sulphas — Codeinae Sulphatis — Codeine Sulphate. — Long glistening 
white crystals, efflorescing in the air. Soluble in 30 parts of water and 6.25 parts of 
alcohol at 25°C. Dose, l grain (0.03 Gm. ), U. S. P. 

Pulvis Morphinae Compositus — Pulveris Morphinae Compositi — Com- 
pound Powder of Morphine (Tully's Powder). — Dose, 5-15 grains (0.3-1.0 Gm.). 

Formula : Morphine Sulphate, 1.5; Camphor, 32; Glycyrrhiza, 33 ; Precipitated 
Calcium Carbonate, 33 ; Alcohol, q. s. to 100. 

The physiological action of opium differs in some respects 
from that of morphine or codeine, and will therefore be described 
first. 

Externally and Locally. — Applied to the unbroken skin, opium 
possesses feeble analgesic properties, and from mucous membranes 
or raw surfaces it is readily absorbed, producing slight anodyne 
effects. 



180 A TEXT-BOOK OF MATERIA MEDICA. 

Internally. — Digestive System. — Its prominent action is upon the 
secretions — checking that from the salivary glands, causing great 
dryness of the mouth and consequent thirst — largely diminishing 
those from the stomach, and reducing the bile and pancreatic juice 
secreted. In fact, every secretion of the body is lessened except 
the perspiration, the cause being the depressing influence of the 
drug upon the secretory centers in the medulla. It may be added 
that the peristaltic movements of the digestive apparatus are re- 
duced, which, together with diminished secretions, impair diges- 
tion and produce constipation. 

The sensation of hunger is invariably diminished under its 
administration. 

The action upon the intestines, however, varies with the dose 
administered, moderate or full medicinal doses checking peristalsis 
and promoting constipation. On the other hand, very large or very 
small doses increase peristalsis, the former augmenting this effect, 
and producing violent movement of the bowels through the drug's 
paralyzing action on the splanchnic inhibitory fibers of the intes- 
tine, so that inhibition is removed and peristalsis reinforced. Very 
small doses act as purgatives when by some reflex disturbance, 
such as a tender ovary, the peristalsis is inhibited. It is not yet 
certain whether this action is largely due to local causes, as mor- 
phine is excreted into the intestines, or is of central origin. Minute 
quantities, by partially benumbing the inhibitory nerves or diverting 
the stimulus from them to the stimulating fibers, relieve constipa- 
tion. This action is rendered serviceable in the similar constipa- 
tion accompanying lead poisoning, the metal constipating the 
patient not only by its astringent action, but also by the tetanic 
spasm of the intestines caused by the irritating action of the lead 
upon the mucous membrane. The feces are held by spasmodic 
intestinal contraction, relief of which by a small dose of opium, 
sufficient to induce peristalsis, will be followed by evacuation. 

Nervous System. — One of the early symptoms of taking opium 
is a condition of well-being — a euphoria. In it the patient is in a 
state of dreamy consciousness ; the skin is warm and pleasant, and 
all outside worries, cares, pains, or distresses are cut off from the atten- 
tion. This is narrowed to the patient's own feeling of happiness. 
Preceding the full development of the euphoria there is little doubt 
that a certain amount of primary stimulation takes place, This 
may be due to the increased blood-supply, frequently manifesting 
itself in the skin by itching, or it may result from primary irritation, 
although experiments on lower animals have induced many 
observers to question the occurrence of any primary stimulation. 
In the habitue there is no doubt of the stimulation of the initial 
Stages, but in this class an entirely different series of physiological 
and psychological activities is at work. In the stage of euphoria a 
certain heightening of the imagination occurs, particularly in certain 
types of mental organization. This readily becomes incoordinated, 
however, and very frequently highly exaggerated, leading to the 



HYPNOTICS. 181 

characteristic fantasies colloquially termed " pipe dreams/' Sleep 
follows -or intermits in this stage. In the light grades of sleep, the 
patient may be easily aroused, and, as a rule, when the outside 
irritant is sufficiently acute to enter into the field of attention, the 
sleeper is suddenly and usually thoroughly aroused. He often 
awakens with a sudden start — is keenly alive to the surroundings, 
and if unnecessary to bestir himself, sinks back into slumber. 
Very often the sleep is a fitful, restless sleep, with semi-waking 
periods and short naps seeming to extend over very great periods 
of time. In the more profound sleep, awakening is difficult and the 
patient, after being aroused, sinks back into a profound coma. 

On awakening, nausea and vomiting are usual, often a severe and 
miserable headache, which persists a part of the following day. 

Spinal Cord. — The action of opium on the spinal cord is com- 
plex, since it contains a number of alkaloids which resemble strych- 
nine as well as morphine, whose action is almost entirely cerebral. 
In the lower animals and in children there is increased reflex excita- 
bility from the action of codeine, narcotine, and thebaine, the last 
resembling strychnine very closely in its action on the reflex motor 
mechanism of the cord. 

Respiration. — The action of opium on the medullary centers is 
very pronounced, particularly upon the respiratory center. 

In very small doses opium slightly stimulates respiration ; in full 
or large doses it is a strong respiratory depressant, its action being 
upon the center in the medulla. Death is usually caused by 
paralysis of respiration, the respirations sinking to 6-8 or even 
less to the minute, and becoming shallower and shallower. In the 
late stages of poisoning Cheynes-Stokes respiration usually develops. 

Circulatory System. — Small doses accelerate the pulse, render- 
ing it fuller and firmer, and dilate the arterioles, though increasing 
arterial tension. The chief activity of opium is on the central nervous 
system. Large doses, while primarily quickening, soon retard the 
heart's action, rendering the pulse slow. This influence is occa- 
sioned by stimulation of both ends of the vagus. Should the dose 
be lethal, the pulse may become rapid and weak from over-stimula- 
tion, and consequent exhaustion of the vasomotor center and 
pneumogastric nerves. As asphyxia deepens, the heart grows 
weaker, but usually continues beating after respiratory failure. 

Absorption and Elimination. — Opium is rapidly absorbed, and is 
eliminated chiefly by the gastro-intestinal mucous membrane and 
very little by the kidneys. 

Moderate quantities of the drug are oxidized in the body, though 
when large doses are administered opium may be found unchanged 
in the urine. It is also excreted in the bile, in the milk, and to 
some extent in the sweat, which is largely increased by opium, par- 
ticularly when the drug is combined with ipecacuanha, as in Dover's 
powder. The sweat is the only secretion augmented by opium, 
although the manner in which sudoriparous glands are stimulated 
is not positively known — whether centrally or peripherally. 



182 A TEXT-BOOK OF MATERIA MEDICA. 

The reabsorption of opium may be prevented by frequently wash- 
ing out the stomach and intestines, from which viscera the drug 
is mainly eliminated. 

Metabolism. — The action of opium on metabolism is very marked. 
It locks it up. Lactic acid occurs in the blood from defective 
oxidization. It diminishes internal cell-oxidization; by limiting 
muscular activity it lessens the muscle metabolism ; and by dimin- 
ishing the excursions of the respiratory muscles, limits respiratory 
oxidation and C0 2 formation. Patients may be kept alive a long 
period of time under the administration of opium, and it plays a 
very important role in the feeding habits of the Orientals. 

Temperature is at first raised, but later lowered when free 
diaphoresis and muscular quiescence are established. 

Eye. — The pupils are minutely contracted by large doses, the 
modus operandi not being fully understood, though probably the 
action is due to stimulation of the oculomotor center. The pupil 
usually dilates just before death. 

Untoward Action. — Headache, disturbances of hearing, muscular 
tremor or temporary paralysis, itching of the skin with or without 
eruption. In case the latter sympton appears, it is commonly in 
the form of a small red spot resembling roseola. An erythematous 
inflammation may affect the mucous membrane of the mouth and 
throat. 

Morphine has produced paresthesia of the sense of taste, as well 
as spasm of accommodation of the eye and edema of the eyelids. 
Many other untoward manifestations occur, even under minute 
doses, in persons having an idiosyncrasy against the drug. 

Tolerance. — It is a notable fact that the body may become readily 
accustomed to morphine, and that a distinct tolerance becomes 
established. Chronic morphine-takers may use enormous quanti- 
ties, some as high as ioo grains of morphine a day. Whether there 
is formed in the body an immune substance, thus permitting of 
such large dosage is not yet established. The researches on dogs 
by Faust and others would seem to show the possibility of an 
antitoxic substance being formed, but the question is still open for 
further investigation. Faust's work also showed that the power 
of the body to oxidize morphine increases. 

Poisoning. — Small medicinal doses of opium, as is known, tend 
to produce moderate excitement, a pleasing sense of freedom from 
care, and in sleep, tranquil, even happy, dreams. Far otherwise it 
is with toxic doses. Under their influence the entire physiological 
conditions of the system are perverted. Here the drug exerts its 
baneful effects, and the mind rapidly succumbs to a power over 
which it has no control. The period of excitement is fleeting, the 
predominating desire of the patient being to sleep, and from the dull, 
lethargic stupor which supervenes he is roused only by vigorous 
and unremitting treatment. Giddiness portends this mental and 
physical state. The pulse, though still full, diminishes in frequency; 
the breathing becomes heavy and labored, and finally stertorous ; 



HYPNOTICS. 183 

the heart is now apparently seized with an indefinable oppression, 
and the pupils are visibly contracted ; the skin is moist and warm, 
and the face suffused or at length of a marked cyanotic hue, cutane- 
ous eruptions being not uncommon. Should relief be not forth- 
coming, the pulse continues to sink ; the drowsiness and subsequent 
lethargy are followed by a state of true coma ; the muscular system 
is wholly relaxed; the reflexes are obliterated, and death ensues 
from respiratory failure, the asphyxia being closely accompanied by 
cessation of the heart's action. The toxic dose ranges from 2 to 10 grs. 

In the treatment of acute opium-poisoning -at least three objects are 
of paramount necessity : to eliminate the poison, maintain respiration, 
and prevent failure of circulation. The first of these may be attained 
by emptying the stomach and evacuating the bowels. Active stimu- 
lants and irritating emetics are of great service, the latter being 
assisted by frequent and copious draughts of warm water in the inter- 
vals of vomiting, and the doses being large in order to make an im- 
pression upon the insensibility of the stomach. Chemical antagonists, 
such as tannic acid, permanganate of potassium, should be tried. 
Physiological antagonists, as caffeine, in hot strong coffee or tea (with 
tannin), and atropine, are the most efficient. Too much atropine 
should not be administered. Hot saline infusions are occasionally 
very helpful in diluting the poison in the blood, Counterirritants, 
flagellation, shouting in the ear, may rouse the patient from his 
lethargy. Artificial respiration by Sylvester's method, or by a 
pump is imperative in the very toxic cases. Awakening the patient 
is very helpful in aiding respiration. 

Chronic opium-poisoning, resulting from the habitual use of opium, 
its most active constituent morphine, or its salts, is undoubtedly 
one of the most pernicious habits to which the human body can 
be subjected, its mental, moral, and physical phenomena being 
among the saddest and most terrible known to therapeutics. 

The conditions inducing the opium habit are frequently caused, 
or are largely influenced, by the therapeutic employment of the 
drug — as was the case with De Quincey, whose graphic analysis 
of the Pleasures and Pains of opium, if possibly to be taken cum 
grano salis, is at once the most powerful and the most eloquent 
ever written. The patient who has once experienced the anodyne 
influence of the drug — as captivating to his senses as though it were 
a draught of the fabled Lethe — readily yields to it upon the slightest 
occasion, as, for instance, to alleviate trivial indispositions for which, 
in ordinary circumstances, he would ridicule the idea of medical 
treatment. With repeated indulgence — often promoted by a casu- 
istic reasoning of which by degrees the subject is scarcely conscious, 
or by persistent and intentional deception — comes the craving which 
knows no restraint, and which can be quieted only by complete 
mental and physical regeneration or the merciful release of death. 

The symptomatology observed in the chronic habitues varies 
considerably. Many people take opium or morphine for many 
years without showing many evil effects. Beyond a marked grade 



184 A TEXT-BOOK OF MA TERIA MEDICA. 

of peculiar anemia, often skilfully hidden by women, and certain 
eccentricities of behavior, even the trained observer may not be 
able to detect even the confirmed habitue, especially when such is 
found under good hygienic and social conditions. These high-grade 
habitues often live a sweet-do-nothing existence, their habit consti- 
tuting one of the family skeletons. 

In the more abject phases severe anemia, with marked pallor, 
extreme emaciation, and greatly depreciated physical, mental, and 
ethical powers are characteristic. 

During the life history of practically every habitue attempts are 
made to overcome the habit. The discontinuance of the drug in- 
variably brings on a series of abstention or withdrawal symptoms 
characterized mainly by stages of vasomotor paresis. Thus, diar- 
rhea with marked painful peristalsis, running from the nose and 
eyes, intense neuralgic pains, and a most distressing restlessness 
are very constant. If the patient can fight it out for thirty-six to 
seventy-two hours these symptoms abate, and there is hope for a 
cure, temporary at least. 

In the treatment of this condition much can be accomplished 
from the purely personal side. Treatment is usually best carried 
out in a trustworthy sanitarium. The general outline will consist 
of substituted sensations ; substituted ideas, and general tonic and 
supportive treatment. To accomplish the former purpose, after 
almost complete withdrawal of the drug has been brought about, 
codeine, heroin, dionin, hyoscine, may be used to create a sense 
of euphoria, which differs in some respects from the old euphoria 
of the drug. The bromide salts in large doses may be employed. 
Suggestive therapy is useful in upholding the morale of the patient. 

The treatment of so dire a malady — for such the chronic use of 
opium must be regarded — demands the utmost forethought, patience, 
and tact. The method of sudden, absolute withdrawal of the drug 
is admitted by the wisest observers to be fraught with danger com- 
mensurate with that of the indulgence to be overcome. Collapse, 
delirium, and other serious results have attended so drastic a meas- 
ure, the general opinion obtaining to-day being that a gradually 
reduced dose of the drug is the safest and most rational mode of 
procedure. The conditions are extremely difficult to combat suc- 
cessfully, repeated hypodermic injections being eradicated from the 
system far less readily than opium from the stomach. The moral 
nature of the patient, too, has become so perverted that little or no 
reliance can be reposed in his veracity, the physician being thrown 
upon his unaided resources, supplemented by the untiring vigilance 
and fidelity of the attendant. 

The gravity of the situation should from the first be fully real- 
ized, since it is too often simply a case of life or death, the patient 
being not infrequently seized with the desire of self-destruction in 
mity of mental anguish occasioned by the ordeal imposed 
by unwonted al>^t ; ;vncc. Could he be put upon his honor, and 
that honor be steadfast, his co-operation would be invaluable. But 



HYPNOTICS. 185 

this assistance is seldom at command, the patient's loyalty of pur- 
pose and unswerving resolution, as professed, being wholly sub- 
servient to a volition long since weakened, if not annihilated, by 
pitiful sophistries and moral degradation. Nevertheless, the case 
must be approached from the sympathetic side, and every means 
of inspiring confidence employed, remembering that a human will, 
as well as body, is under treatment, and that mental sanity, as well 
as physiological health, is to be restored. 

Of the many agents suggested as general tonics, are valerianate 
of ammonia, fluidextract of coca or camellia, easily digested and 
strengthening food, and, if necessary, alcoholic stimulants, have 
been especially beneficial. 

Change of scene, a healthful, stimulating diet, and abundant out- 
door exercise — always favorable to diversion of thoughts — seldom 
fail to react encouragingly upon the mind and physique of the pa- 
tient. The exhibition of symptomatic remedies not indicated has 
been authoritatively condemned, the primary object of treatment 
being not so much to afford temporary relief of pathological con- 
ditions as to remove the dominating cause. While a successful out- 
come is not always to be expected, much can be accomplished by 
persistent effort in these cases. They are not hopeless by any 
means. 

Therapeutics. — In a general way the medical uses of opium 
are — 1, to relieve pain ; 2, to produce sleep ; 3, to lessen reflex irri- 
tation ; 4, to diminish secretion; 5, to support the system; 6, to act 
as a sudorific. 

Opium is the most important and useful drug known to medi- 
cine, as well as the most remarkable in its multifarious applications. 
It would, therefore, be idle — indeed, well-nigh impossible — to enu- 
merate all the maladies and abnormal conditions for which this 
invaluable remedy has been employed. It perhaps best represents 
the typical symptom medicine, being used almost invariably for the 
relief of one or more symptoms of disease, rather than for its specific 
or direct curative action upon the disease itself. Unless some special 
contraindication exists, it may be employed when any of the above 
medical uses are desired. 

Externally and Locally. — It is used to relieve pain, either in the 
form of an ointment, a liniment, or a suppository, an aqueous solution 
of morphine sulphate as a collyrium in cojijnnctivitis, in the form of 
bougies, injections, snuff, or lozenges, or solution in diseases of the 
genito-nrinary tract, the ear, nose, and throat. 

Tincture of opium is frequently added to flaxseed poultices to 
allay the pain of superficial inflammation. 

Pain. — Either opium or morphine may be used for the relief of 
pain, regardless of the seat or cause. Pain of moderate intensity may 
often be allayed by other analgesics, such as antipyrine, acetanilid, 
etc. ; but when it is severe or excruciating, it is useless to experi- 
ment with other drugs when so potent an agent of relief as 
opium is obtainable. As a general principle, it should be borne in 



1 8.6 A TEXT-BOOK OF MATERIA MEDIC A. 

mind that opium should, if possible, be avoided in all pains of an 
essentially chronic nature, if the habit is not to be acquired. 

Sleep. — It is not recommended for ordinary use to produce sleep, 
because of its seductive, insidious action, and the danger of creating 
in the patient a tendency toward the opium habit. When, how- 
ever, sleeplessness is occasioned by pain, and in the insomnia of 
delirium tremens or acute delirium, opium or some one of its prepa- 
rations is often an indispensable remedy. 

Spasm. — Spasmodic conditions of involuntary muscles, as in cases 
of asthma, the convulsions of tetanus, uremia, hydrophobia, frequently 
call for a drug as powerful as opium. 

When given in proper doses in peritonitis, opium reduces peri- 
stalsis and removes the pain, promoting the patient's comfort and 
supporting his vital powers. It diverts the blood from the congested 
peritoneum by dilating the cutaneous blood-vessels. Furthermore, 
it possesses the peculiar property of causing the irritation in the 
inflamed area to contract reflexly the local blood-vessels, thus di- 
minishing the blood-supply to the diseased part. 

It is manifestly of little service beyond its pain-relieving effects 
in the peritonitides of septic appendicitis or of other acute bacterial 
peritonitides. If its use tends to mask the symptom of pain in 
appendicitis, thus rendering diagnosis more difficult, it is to be 
avoided. 

Secretion. — In dysentery, cholera morbus, and cholera, it has been 
used with excellent results, having also been employed in many 
cases of excessive secretion in other portions of the body. 

Opium is frequently given in bronchitis with profuse secretion 
and irritable cough, in which condition it acts favorably through 
depression of the reflexes and power to allay irritation and check 
secretion. In these cases, however, small doses only should be 
administered, and the condition of the patient carefully watched, 
especially that of the aged, lest the respiratory apparatus be so de- 
pressed that expulsion of the accumulated viscid mucus be impos- 
sible and danger of death from suffocation ensue. 

Metabolism. — As a supporter of the system when the vital forces 
are weakened by acute or chronic disease or injury there are 
few drugs as efficacious as opium. It calms and strengthens the 
debilitated heart, and secures the patient refreshing sleep, soothing 
and invigorating his system by means of the much-needed rest. 
If pain be persistent, wearing seriously upon the sufferer's vitality, 
opium by its anodyne influence enables him to recuperate during 
the interval of relief. 

In shock from severe injury, opium, by benumbing sensation 
and depressing the reflex mechanism, lessens the danger of cardiac 
and respiratory failure. 

In pleurisy it is the most efficient remedy, relieving congestion 
as in peritonitis, besides reducing the respirations, and consequently 
the friction of the inflamed pleural surfaces, as well as allaying the 
each respiration. 



HYPNOTICS. 187 

Dover's powder is a common and valuable agent in acute coryza, 
it also being one of the most efficient diaphoretics. 

Opium is considered the most efficacious remedy in puerperal 
septicemia. It has also been advocated for hemorrhage, both active 
and passive, its greatest utility being manifested in the latter con- 
dition. It is particularly valuable in the hemoptysis of phthisis, 
and useful in hemorrhage in typhoid. 

Although frequently used in continued fevers of various kinds, 
it is indicated, as a rule, only during their course — or, rather, after 
the fever is well established or during its decline — to mitigate its 
violence or conserve the strength and relieve the nervous manifes- 
tations foreboding exhaustion. Clinical experience has demonstrated 
its inutility, ordinarily, at the onset or climax of such fevers. Even 
in exanthematous fevers opium has proved valuable when the erup- 
tion is delayed. The presence of narcotine is said to be of assistance 
in the treatment of malaria. 

As already intimated, the space allotted to this drug will scarcely 
permit an enumeration of the many disorders for which this remedy 
has been successfully administered. The independent and thought- 
ful physician, knowing the chief indications for its use, will find no 
difficulty in employing opium alike to the relief of the patient and 
his own satisfaction. 

Contraindications. — If avoidable, opium should not be given to 
children under five years of age. Should the necessity of adminis- 
tration under that age be deemed advisable in the judgment of the 
physician, it should be remembered that the drug acts with greatly 
disproportionate power upon the nervous systems of the young, 1 
minim (0.06 Gm.) of tincture of opium having caused the death of a 
child one day old, and a few drops of camphorated tincture of 
opium having proved fatal to an infant of nine months. The death 
of a nursing babe is even recorded ; the mother having taken a 
medicinal dose of laudanum. 

Opium is contraindicated in excessive bronchial secretion of the 
aged, during the second stage of pneumonia, in cerebral congestion, 
and in alcoholism. 

Administration. — As has been stated under Poisoning, there are 
many circumstances which modify the action of opium, the young 
and the old requiring smaller doses and great care in administra- 
tion. For children the best preparation is paregoric. Females, 
moreover, need smaller doses than males, since they are more readily 
affected by the drug and more subject to untoward manifestations, 
such as nausea, headache, etc. 

Caution should be exercised in administering opium to those who 
have an idiosyncrasy against it. On the other hand, persons addicted 
to the opium habit require enormous doses to make a medicinal 
impression. 

Agonizing pain seems to antagonize the drug, so that in peri- 
tonitis or during the passage of biliary or renal calculi, in severe 
neuralgia, tic doloureux, etc., opium is well borne, doses which 



1 88 A TEXT-BOOK OF MATERIA MEDIC A. 

under other conditions might produce dangerous symptoms having 
little effect save to deaden the pain, frequently not even inducing 
sleep. 

In other cases, such as nephritis, very small doses may be fol- 
lowed by serious and alarming consequences, continued adminis- 
tration resulting in an accumulation of the drug in the system, 
owing to defective elimination. Should prolonged administration 
be desirable, it is necessary to increase the dose gradually in order 
to produce the requisite effect, because of the growing tolerance 
to the drug. 

Certain preparations are preferable in given conditions. Thus, 
if it be necessary to produce diaphoresis, Dover's powder or some 
other combination with ipecac is advisable. When relief of pain, 
unless it be intense, is desired, small doses of morphine or tincture 
of opium will usually be sufficient, full doses being required to 
produce sleep. 

The deodorized tincture of opium causes less disagreeable symp- 
toms than the plain preparation, which contains narcotine. Potas- 
sium bromide is said to prevent untoward after-effects. 

When opium is demanded for its astringent action, it should be 
given in small or stimulant doses or combined with chalk or with 
some of the astringents. The camphorated tincture, owing to the 
camphor it contains, is probably the most astringent liquid prepara- 
tion of opium, and is therefore preferable in cases of diarrhea, as it 
is the favorable form as an adjunct to cough-mixtures. 

When the prolonged sedative and astringent effect of opium is 
desired, as in intestinal hemorrhage, diarrhea, nausea, and certain 
diseases of the stomach, an old, dry opium pill or pill of opium 
and lead is better than any liquid preparation of morphine, owing 
to its tardy solution. 

In diseases of the rectum requiring opium a suppository contain- 
ing the extracts of opium and belladonna is perhaps the best com- 
bination to use. 

Ovarian and pelvic pain more readily succumbs to the anodyne 
action of codeine than distress in other parts of the body. 

When opium is used as a soporific, it is best to combine it with 
chloral, a small dose only of each being necessary. These unite 
in their action upon the brain, depressing the heart less than if 
chloral alone had been given, and are attended by less serious after- 
effects than had morphine been the sole agent employed. 

Opium prolongs the narcotic effect of chloroform, and in cer- 
tain operations it is good practice to administer a dose of the drug, 
following it soon with a few inhalations of the anesthetic. 

The hypodermic injection of morphine is usually preferable to 
the internal administration of opium in cases of severe pain, since 
a smaller dose is required and a much more rapid effect produced, 
with less danger of affecting the appetite and bowels. 

The many circumstances influencing the action of the drug 
appear to confirm the statement that "there is no dose of opium," 



HYPNOTICS. 189 

its conduct being wholly dependent upon the age, sex, idiosyn- 
crasies, and condition of the patient. The amounts given under 
the different preparations are such as experience has shown to be 
safe ordinarily as the initial ones for adults, succeeding doses being 
adjusted according to the indications of the individual case. 

Antagonists and Incompatibles of Opium and its Alkaloids. 
— The physiological antagonists are atropine, strychnine, coffee Or 
caffeine. Quinine antagonizes some of the cerebral effects of the 
drug, while tartrate of antimony and potassa (tartar emetic) and 
digitalis oppose its action on the intracranial circulation. The incom- 
patibles are alkalies, tannic acid and infusions containing it, and 
salts of lead, iron, copper, mercury, and zinc. 

The following are incompatible with morphine and its salts : 
iodine and iodides, bromine and bromides, Fowler's solution, and 
sodium borate. 

Synergists. — The hypnotic action of opium is aided by the 
hypnotics ; its anodyne influence is enhanced by belladonna and 
cocaine, and its sudoriferous effects by ipecacuanha. 

Contrasts of Opium and its Alkaloids. 

It has been pointed out that opium is a very variable body. Its 
chief action is dependent on morphine, which is found, as a rule, in 
the largest amounts. Occasionally the morphine strength is low, 
and thebaine or narcotine percentage high. In this event the 
tetanizing activities of these alkaloids becomes prominent. The 
alkaloids in opium seem to show a regular series of gradations in 
activity from morphine, through papaverine, codeine, and narcotine, 
to thebaine ; in the former of which the cerebral activities are more 
manifest, while for narcotine and thebaine there is greater action on 
the spinal reflexes. Narcotine approaches strychnine in this respect. 

Morphine is naturally much more certain in its action than opium. 
Papaverine is intermediate between morphine and codeine, but is a 
weak alkaloid. 

Codeine represents a middle activity. It is less depressing to 
the cerebral functions, and much less poisonous to the medulla ; in 
children its stimulating action on the spinal cord may be manifest. 
It is much weaker than morphine, and rarely causes the unpleasant 
after-effects of this alkaloid. 

The remaining alkaloids are present in very small quantities and 
are therapeutically negligible. Narceine was at one time considered 
highly poisonous, but later research has failed to confirm Claude 
Bernard's early dicta. 

Allied Morphine Compounds. 

Heroin — Diacetyl Morphine. — This is an acetic ester of morphine. It is a 
white crystalline powder, of faintly bitter taste, but practically insoluble in water, but 
rendered soluble with dilute acids. It is useful as a substitute for morphine as an anti- 
spasmodic in cough, and is particularly valuable in respiratory difficulties. It is less 
of a cerebral depressant. Its use can bring about a habit. Dose, ^-\ grain (0.005-0. 1 
Gm.). 



19° A TEXT-BOOK OF MATERIA MEDIC A. 

Dionine — Monacetyl Morphine Hydrochloride. — This is much similar to the 
preceding, a single acetyl ester entering into the combination. It has much the same 
properties, but is deemed more poisonous. Severe poisoning has resulted. Dose, not 
to exceed -1- grain (0.012 Gm.). 

Peronine. — This is an analogous compound — the benzyl ester of morphine. It is 
a soluble white powder, and resembles codeine in action, over which it has no advan- 
tages and some disadvantages. Dose, up to 1 grain (0.06 Gm. ). 

Humulus— Humuli— Hops. ZT. S. JP. 

Definition. — The carefully dried strobiles of Humulus Lupulus L. bearing their 
natural glandular trichomes. 

Description and Properties. — Ovate, about 3 Cm. long, consisting of a 
thin, hairy, undulating axis and numerous obliquely ovate, membranaceous scales, the 
upper portion of which is reticulately veined and the lower parallel-veined, glandular, 
surrounding a subglobular akene ; color of the scales greenish, free from reddish or 
brownish spots, odor aromatic, and taste bitter, aromatic, and slightly astringent. The 
active and important constituent is — 

Lupulinum— Lupulini— Lupulin. IT. S. P. 

Definition. — The glandular trichomes separated from the fruit of Humulus 
Lupulus L. 

Description and Properties. — Bright, brownish-yellow, becoming yellowish- 
brown, resinous, consisting of minute glands which under the microscope are seen to 
be subglobular, or, rather, hood-shaped, and reticulate — aromatic and bitter. 

Dose Of Lupulin.— 5-30 grains (0.3-2.0 Gm. ). 

Official Preparations of Lupulin. 

Fluidextractum Lupulini — Fluidextracti Lupulini. — Fluidextract of Lupu- 
lin. — Dose, 5-30 minins (0.12-2.0 Cc. ). 

Oleoresina Lupulini — Oleoresinae Lupulini — Oleoresin of Lupulin. — Dose, 
1-5 grains (0.06-0.3 Gm. ). 

Physiological Action. — Internally. — Digestive System. — The ac- 
tion of hops is similar to that of vegetable bitters, augmenting the 
secretions from the salivary and gastric glands, thereby promoting 
appetite and digestion. 

Circulatory System. — The heart's action is slightly increased, the 
remedy also raising arterial tension and exciting the cutaneous cir- 
culation. 

It was at one time thought that hops had a soporific action like 
opium, but beyond a slight activity due to its volatile oils it is phy- 
siologically and therapeutically inert. 

The combined tinctures of lupulin and capsicum serve as excel- 
lent substitutes for alcoholic stimulants during the treatment of 
alcoholism, as well as being useful remedies in mild attacks of delir- 
ium tremens. 

Administration. — Lupulin and oleoresin of lupulin are best 
given in pills and capsules respectively. The tincture and fluid- 
extract should be administered in syrup. 

Lactucarium— Lactucarii— Lactucarium. U. S. P. 

Definition. — The concrete milk-juice of Lactuca virosa L., a biennial rank- 
smelling herb growing in Europe. 

Description and Properties. — It occurs in sections of plano-convex, cir- 



HYPNOTICS. 191 

cular cakes, or in irregular, angular pieces, externally grayish-brown or dull reddish- 
brown, internally whitish or yellowish, of a waxy luster, heavy narcotic odor, and 
somewhat bitter taste. It contains lactucin, lactucopicrin, lactucic acid, lactucerin, 
and wax. 

Dose. — 5-60 grains (0.3-4.0 Gm.). 

Official Preparations. 

Tinctura Lactucarii — Tincturae Lactucarii — Tincture of Lactucarium. — ■ 

Dose, \-2 fluidrachms (1.0-8.0 Cc). 

Syrupus Lactucarii — Syrupi Lactucarii — Syrup of Lactucarium. — Dose, 1- 
4 fluidrachms (4.0-15.0 Cc. ). 

Physiological Action and Therapeutics. — It has been thought 
that lettuce contains a body somewhat resembling hyoscyamine. 
If this is so the reputed soporific effects are explainable. Its action 
is in nowise like opium. It is extremely slightly soporific and also 
diuretic, which properties, especially in the syrup form, render it of 
some value in cases of irritating cough, as well as in sleeplessness and 
nervousness of children. 

Cannabis Indica— Cannabis Indicae— Indian Can- 
nabis. U. S. P. 

(Indian Hemp.) 

Definition. — The dried flowering tops of the pistillate plant of Cannabis sativa L., 
grown in the East Indies and gathered while the fruits are as yet undeveloped and 
carrying the whole of their natural resin. 

Description and Properties. — The article of commerce consists of bundles 
of a few flowers, the branches and bracts, and nearly ripe fruit, the whole more or less 
agglutinated by a resinous exudation. Of a brownish-green color, peculiar narcotic 
odor, and slightly acrid taste. The exact composition of cannabis is not known. It 
is an extremely variable drug, and plants in different countries display great diversity 
in amount of active constituents. It is thought that only the tropical varieties are 
effective. 

The active constituents are not yet definitely isolated. They exist in a mixture of 
resins and volatile oils, termed for convenience only Cannabinol ; but no one body 
that may be said to possess the pharmacological characters of the crude drug has yet 
been positively determined as to its chemical structure. 

The crude drug is commonly called in India "gunjah." "Bhang," " siddhi," 
or " hashish," the term usually employed — from whose toxic effects, frequently inciting 
to murder, is said to be derived our word "assassin" — is another form of cannabis 
appearing as the Arabian confection prepared by mixing aromatics with fruits and 
dried leaves. 

Dose. — 2-5 grains (0.12-0.3 Gm.). 

Official Preparations. 

Extractum Cannabis Indicae — Extracti Cannabis Indicae — Extract of In- 
dian Cannabis.— Dose, \-\ grain (0.015-0.06 Gm.) [i grain (0.01 Gm.), U. S. P.]. 

Fluidextractum Cannabis Indicae— Fluidextracti Cannabis Indicae — Fluid- 
extract of Indian Cannabis. — Dose, 2-5 minims (0.12-0.3 Cc). 

Tinctura Cannabis Indicae (10 per cent.) — Tincturae Cannabis Indicae — 
Tincture of Indian Cannabis. — Dose, 5-20 minims (03-1.2 Cc). 

Physiological Action. — Externally and Locally. — Its local 
action on the skin is nil. 

Internally. — Digestive System. — It is slightly sedative to the 



192 A TEXT-BOOK OF MATERIA MEDICA. 

stomach, in many persons appearing to promote the appetite and 
aid digestion. Its use is not followed by constipation or other 
gastro-intestinal disturbance. 

Nervous System. — In moderate-sized doses after half to one hour 
there is a marked stimulation of the cerebral activities. The flow 
of ideas is heightened. Imagination is quickened and in certain 
types of individuals there may be hallucinations of sight, of hear- 
ing, of touch, etc. These are for the most part accompanied by 
a dreamy state of beatitude, atypical euphoria, comparable in some 
degree to the euphoria of alcohol or opium. Certain psychological 
peculiarities are often noted in the mental exaltation. Double con- 
sciousness, or sense of divided consciousness, is common, and there 
is usually a loss of space and time relations. The peripheral nerves 
of touch and pain are affected, both of these sensations being dulled. 
Medullary functions of respiration and circulation are not much 
affected, although the heart is slightly accelerated and the respira- 
tion somewhat slowed unless there is excitement. There may be 
heightened reflex irritability in the cord. 

Absorption and Elimination. — Cannabis is slowly eliminated, 
though in what manner is unknown, the effects of the drug some- 
times persisting for twenty-four or thirty-six hours. Of all the 
secretions, the urine alone is affected, the amount being increased. 

Temperature. — Cannabis has no direct depressing action upon 
temperature, which, however, may rise during the period of excita- 
tion, and be diminished somewhat during sleep. 

Eye. — The drug differs from opium in that it dilates the pupil 
and produces exaggerated vision. 

Uterus. — It is considered to be a powerful uterine stimulant, and 
like properties are usually ascribed to it as an aphrodisiac, though 
its effect upon sexual desire is not always manifest. It undoubt- 
edly increases the energy of the uterus, though possessing no power 
to inaugurate uterine contractions when once suspended. 

Poisoning. — Large doses of cannabis Indica are wont to produce 
toxic effects, but these are rarely fatal even in large doses. Cardiac 
failure is thought to precede respiratory paralysis. 

The after-effects of hashish indulgence vary with the physiolog- 
ical and mental peculiarities of the individual. As a rule, they are 
not disagreeable, though it requires time to eradicate the effects of 
the poison. Death directly attributable to the drug has not been 
recorded. 

Treatment of Acute Poisoning. — Among antidotes, lemon-juice, 
coffee, and tobacco have been favorably mentioned. The best treat- 
ment appears to be similar to that adopted in cases of chloral- and 
opium-poisoning. 

Chronic poisoning induces a characteristic series of mental symp- 
toms. The effects of continued indulgence, according to the 
Makhzan-el-Adwiya, an early treatise, are "weakness of the 
digestive organs, followed by flatulency, indigestion, swellings of the 
limbs and face, changes in complexion, diminution of sexual vigor, 



HYPNOTICS. 193 

loss of teeth, heaviness, cowardice, depraved and wicked ideas." 
The most common effect, however, is the development of insanities 
which have been known for many years. A number of types are 
described. Temporary intoxication is the state commonly seen in 
the hashish cafes of the Orient. The patient represents a medium 
condition between an alcoholic and an opium intoxication. Hashish 
delirium represents a severer grade comparable to delirium tremens. 
The patients are restless and sleepless and chatter unendlessly. 
Acute maniacal excitement is also found. The patient runs amuck, 
but may also be melancholic. Chronic mania and dementia repre- 
sent terminal stages. The mania is usually a happy mania. The 
dementia is of a classical organic type. A further form of the 
cannabino-mania needs characterization. He is the shiftless never- 
do-well — a liar and thief, quite comparable with the degenerated 
alcoholic, opium, or cocaine habitues. 

Therapeutics. — Externally and Locally. — Cannabis is very sel- 
dom used locally. 

Internally. — Cannabis has been discarded as a remedy in many 
disorders for which it was formerly used. It is, however, still em- 
ployed to a considerable extent as a hypnotic in melancholia and 
mania and for its analgesic action in neuralgia and pruritus. 

Cannabis Indica is of service in functional impotence, its action 
in this disorder being aided by combining it with ergot and nux 
vomica. 

It is a valuable adjuvant to cough-mixtures intended to relieve 
tickling or irritation of the throat, as well as to quiet the excessive 
cough of bronchitis or phthisis, being superior to opium in this 
respect, since it disturbs the stomach less and does not produce 
constipation. 

It has been used in spasm of the bladder, and in gonorrhea and 
chordee it has been found to be a most valuable remedy. 

In considering the therapeutics of cannabis Indica reference 
should be made to its efficacy in migraine and headache, particu- 
larly those present at the menopause. Although as a remedy for 
the former disorder cannabis has been largely superseded by the 
adoption of antipyrine and agents of its class, the old use of tinc- 
ture of gelsemium, combined with tincture of cannabis, serves an 
important purpose in aborting the distressing attacks of migraine. 
It is useful as a mild hypnotic in insomnia from exhaustion with 
pain, and is often efficient in severe tic douloureux. 

Administration. — The extract should be given in pill form ; the 
tincture and fluidextract, in an alcoholic menstruum. As has been 
already intimated, different samples vary greatly in strength ; it is 
therefore best to begin with the minimum dose until the force and 
quality of the preparation be ascertained. 

It is advisable to prescribe invariably the preparations of that 
particular manufacture which experience has shown to produce 
samples of uniform strength. 

13 



194 A TEXT-BOOK OF MATERIA MEDICA. 

BROMIDES. 

Potassii Bromidum— Potassii Bromidi — Potassium Bromide (U. S. P.). — 
Origin. — Prepared by adding bromine to a solution of potassa, evaporating to dryness, 
mixing with charcoal, heating to redness, dissolving in water, and crystallizing. It 
should contain not less than 97 per cent, of pure potassium bromide. 

Description and Properties. — Colorless or white cubical crystals or granules, odor- 
less, with a pungent, saline taste; permanent in air; soluble in about 1.5 parts of 
water and in 180 parts of alcohol at 25 ° C. 

Dose. — 5-60 grains (0.3-4.0 Gm. ) [15 grains (i Gm.), U. S. P.]. 

Sodii Bromidum— Sodii Bromidi— Sodium Bromide (U. S. P.). — Origin. — 
Obtained from a solution of soda in the same manner as potassium bromide. It should 
contain when dried not less than 97 per cent, of pure sodium bromide. 

Description and Properties. — Colorless or white cubical crystals, or a white gran- 
ular powder, odorless, and with a saline, slightly bitter taste. From air the salt 
abstracts moisture without deliquescing. Soluble in 1.7 parts of water and in 12. 5 
parts of alcohol at 25 C. It should be kept in well-stoppered bottles. 

Dose. — 10-60 grains (0.6-4.0 Gm. ) [15 grains (1 Gm.), U. S. P.J. 

Ammonii Bromidum — Ammonii Bromidi — Ammonium Bromide (U. S.P.). 
— Origin. — Obtained by neutralizing hydrobromic acid with ammonia or ammonium 
carbonate, evaporating, and crystallizing. It should contain not less than 97 per 
cent, of pure ammonium bromide. 

Description and Properties. — Colorless, transparent, prismatic crystals, or a white 
crystalline powder, odorless, and of a pungent, saline taste ; permanent in the air. 
Soluble in 1.2 parts of water and in 1 2. 5 parts of alcohol at 25 C. 

Dose. — 5-30 grains (0.3-2.0 Gm.) [15 grains (1 Gm.), U. S. P.]. 

Lithii Bromidum — Lithii Bromidi — Lithium Bromide (U. S. P.). — Origin. — 
Prepared by a solution of ferrous bromide and lithium carbonate, the cool liquid 
being evaporated and crystallized. It should contain when well dried not less than 
97 per cent, of pure lithium bromide. 

Description and Prope?'ties. — A white granular salt, odorless, and having a sharp, 
slightly bitter taste ; very deliquescent. Soluble in 0.6 part of water and very soluble 
in alcohol. It should be kept in well-stoppered bottles. 

Dose. — 5-20 grains (0.3-1.2 Gm.) [15 grains (1 Gm.), U. S. P.]. 

Calcii Bromidum — Calcii Bromidi — Calcium Bromide (U. S. P.). — Origin. 
— Prepared by dissolving pure calcium carbonate in hydrobromic acid and evaporating. 
It should contain not less than 97 per cent, of pure calcium bromide. 

Description and Properties. — A white granular salt, odorless, of a sharp, saline 
taste, and very deliquescent. Soluble in 0.5 part of water and in I part of alcohol at 
25 C. It should be kept in well-stoppered bottles. 

Dose. — 10-30 grains (0.6-2.0 Gm.) [15 grains (i Gm.). U. S. P.]. 

Zinci Bromidum — Zinci Bromidi — Zinc Bromide (U. S. P.). — Origin. — Pre- 
pared by digesting granulated zinc in hydrobromic acid, concentrating the solution, 
acidulating with hydrobromic acid, and drying upon a water-bath. It should contain 
when anhydrous not less than 97 per cent, of pure zinc bromide. 

Description and Properties. — A white granular powder, odorless, and having a 
sharp, saline, and metallic taste. Very deliquescent. Readily soluble in water and 
alcohol. 

Dose. — 1-5 grains (0.06-0.3 Gm.) [2 grains (0.025 Gm.), U. S. P.]. 

Strontii Bromidum — Strontii Bromidi— Strontium Bromide (U. S. P.). — 
Origin. — Obtained by neutralizing hydrobromic acid with strontium carbonate, filtration, 
and evaporation. It should contain not less than 97 per cent, of pure strontium 
bromide. 

Description and Properties. — Colorless, transparent, hexagonal crystals, odorless, 
and having a bitter, saline taste. Very deliquescent. Soluble in 1 part of water and 
readily soluble in alcohol. 

Dose. — 5-30 grains (o. 1 r 2.oGm.) [15 grains fi Cm. I, U. S. P.], 

Acidum Hydrobromicum Dilutum — Acidi Hydrobromici Diluti — Diluted 
Hydrobromic Acid (l*. S. P.). — Definition. — A liquid composed of not less than io 
per cent, by weight of absolute hydrobromic acid and 00 per cent, of water. 

Description and Prop,) ties. — A clear, colorless liquid, odorless, and having a 
Strongly acid taste. Miscible in all proportions with water and alcohol. It should be 
kept in gla — toppered bottles, protected from light. 

Dose. — 20 minims to 2 fluidrachms ( 1. 23-7. 39 Cc.) [l drachm (4 Cc), U. S. P.]. 



HYPNOTICS. 195 

Bromoformum — Bromoformi — Bromoform (U. S. P.). — Definition. — A liquid 
consisting of 99 per cent, by weight of absolute bromoform (CHBr 3 ),and I per cent, 
of absolute alcohol. 

Obtained by the action of bromine upon equal parts of methylic alcohol and caustic 
potash. 

Description and Properties. — A heavy, transparent, colorless, mobile liquid having 
an ethereal odor and a penetrating, sweetish taste resembling chloroform. It is only 
slightly soluble in water, but readily in alcohol and ether. Specific gravity at 25 C, 
2.808. It is only slightly volatile at ordinary temperature, boils at I48 C.,and solidi- 
fies at 6° C. 

Absolute bromoform is decomposed in presence of light and air more rapidly than 
chloroform. The addition of 4 per cent, of alcohol, as in the case of chloroform, 
will preserve bromoform for months. When decomposed, bromine is set free, which 
colors the liquid yellowish red. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Antagonists and Incompatibles. — The bromides are antago- 
nized by the motor excitants and muscle stimulants. The incom- 
patibles are acids, acidulous and metallic salts. Spirit of nitrous 
ether is incompatible with the ammonium bromide. 

Synergists. — Their action upon the brain is enhanced by opium 
and the hypnotics, while the cardiac depressants increase the effect 
of potassium bromide upon the circulatory system. 

Physiological Action. — The action of the bromides depends 
upon both ions found in the salt, since practically all are disso- 
ciable. Thus each bromide salt shows a certain amount of variation 
in its reaction. The action of the bromine ion is distinctive, how- 
ever. The actions of the Na, K, NH 4 , Li, Zn, and Sr ions are also 
distinctive and obey the general laws of the inorganic salts. Potas- 
sium bromide being the most widely employed, its action will be 
considered in detail first. 

Externally and Locally. — Potassium bromide is slightly seda- 
tive to mucous membranes when applied locally, lessening the 
reflex irritability, particularly of the pharynx. 

Internally. — Digestive System. — Locally on the mouth and 
stomach it produces increased salivation and irritation, as a result 
of its salty taste. Excessive doses have occasioned a sense of cold- 
ness in the epigastrium, with nausea and looseness of the bowels. 

It is freely and rapidly absorbed, traces being found in the urine 
in a few minutes. Accumulation takes place because of compar- 
atively slow elimination of the entire amount ingested. Equilibrium 
of intake and outgo is, however, soon established. The salts are 
evenly distributed throughout the body, but the chief action is on 
the nervous system. 

Nervous System. — Potassium bromide acts as a depressant to the 
cerebrum. It causes a retardation of the flow of ideas and somno- 
lence. The functions of the motor areas are also depressed. This 
action on the cerebrum is believed to be due to the bromine ion. 
The sleep caused is of a dull and heavy character, not refreshing, 
and is not induced in the presence of pain, or great mental anxiety, 
or grief. On the medulla there is no marked action. 

Spinal Cord. — Potassium bromide diminishes the reflex excita- 



196 A TEXT-BOOK "OF MATERIA MEDICA. 

bility of the spinal cord. This with its action on the motor centers 
causes marked depression in muscular activity. 

Respiratory System. — Under full doses the respirations are 
slower and shallower, owing to slight depression of the respiratory 
center, paralysis of which may cause death, although fatal paralysis 
may affect the heart because of the poisonous influence of the 
potassium ion upon the cardiac muscle. 

Circulatory System. — Potassium bromide depresses the circula- 
tion, causing the pulse to become slower, softer, and weaker, and 
shortening the systole while prolonging the diastole of the heart. 
The caliber of the vessels is diminished, although arterial pressure 
is lowered. The potassium ion is responsible for the cardiac de- 
pression. It is not present in the other bromide salts. 

There is also a marked diminution, under large and continued 
dosage, in the activity of the sexual function, and the muscular 
power of the bladder is somewhat impaired. Anesthesia of the 
bladder, joints, skin, and mucous surfaces is a constant symptom 
of prolonged administration. 

Absorption and Elimination. — The bromides are very rapidly 
absorbed, and begin to be eliminated quickly, chiefly by the kidneys 
(increasing the flow of urine), and also by the skin, saliva, intestinal 
and mammary glands, and the bronchial mucous membrane. The 
sulphur nitrogen and chlorides in the urine are increased and the 
amount of phosphates decreased. 

Nothwithstanding the rapid elimination of the bromides, under 
prolonged administration they tend to accumulate in the system, 
being found abundantly in all parts of the body, particularly in the 
blood. Nerve-structures contain small amounts. The drug is 
often found in the urine several weeks after stopping its adminis- 
tration. It has been thought that the bromides were able to re- 
place the chlorides in the tissues to a certain extent. This deduc- 
tion has been made the basis of an important hypothesis for the 
treatment of epilepsy — to be considered later. 

Temperature. — Immoderate doses cause a reduction of temper- 
ature, due to depression of the circulation and lessening of tissue- 
change. 

Eye. — There may occur dilatation of the pupil, conjunctival 
catarrh, diplopia, amblyopia, dimness of vision, and dilatation of 
the retinal blood-vessels. 

Uterus. — A diminution of the catamenia may sometimes be present. 

Untoward Action. — The susceptibility of individuals to the un- 
toward action of the bromides is extremely variable. The symp- 
toms observed are — gastric uneasiness with eructation, nausea and 
vomiting, analgesia of the epiglottis and pharynx, bronchial catarrh, 
hoarseness and cough, acute coryza and conjunctivitis, offensive 
breath, dysuria, diminished sensibility of the genito-urinary mucous 
membrane, and a variety of cutaneous eruptions. 

Poisonings — Bromisnty as the symptoms of poisoning are termed, 
may be divided into an acute and a chronic form. 



HYPNOTICS. 197 

Acute Bromism, resulting from a single toxic dose, is manifested 
by violent frontal headache, great muscular weakness, incoordi- 
nation of movements, abolition of reflexes, somnolence, slow and 
shallow breathing, subnormal temperature, lusterless eyes, and 
very slow and weak pulse, death usually extremely rare, resulting 
from either respiratory or cardiac failure. Death has resulted from 
2 J ounces (75 Gm.) taken in a period of forty-eight hours. Treat- 
ment of acute bromism is best effected by salt solution by hy- 
podermoclysis, enteroclysis, or infusion. 

Chronic Bromism, caused by prolonged use of the bromides, is 
characterized by mental apathy, constant drowsiness, hallucinations, 
depression, considerable cutaneous anesthesia, muscular weak- 
ness, poor circulation, cold extremities, marked anemia, impairment 
of the sexual function, deranged digestion, and cutaneous eruptions 
of various forms collectively designated as " bromine acne." 

Its continued use over years may result in permanent mental 
impairment. X 

Treatment* of Poisoning. — The drug should be immediately 
withdrawn and methods adopted to hasten elimination, such as the 
administration of diuretics, cathartics, etc. Tonics, such as strych- 
nine, iron, and the cardiac stimulants, should be given, while exer- 
cise and change of scene may counteract the psychical symptoms. 

It is claimed that the daily administration of Fowler's solution 
causes a rapid disappearance of bromine eruption. 

Comparative Action of the Bromides. — Potassium bromide 
contains 66 per cent, of bromine. It is the most toxic to the heart 
and muscular system. 

Sodium bromide, 78 per cent, of bromine, is less hypnotic, as 
the sodium ion is known to increase cerebral activity, but the 
Na ion being indifferent to heart and muscle, it is less toxic. 

Ammonium bromide, containing the NH 3 ion, shows slight cardiac 
stimulation, but is otherwise identical with the potassium salt. 

Lithium bromide is the richest in bromine, containing 92 per 
cent., and is probably the most hypnotic of all. Its action more 
nearly resembles that of the sodium salt. 

Calcium bromide, while resembling them in its action, is less 
energetic than the other bromides. 

Zinc bromide is the most irritant, and is supposed to possess 
both tonic and sedative properties. 

Strontium bromide is the mildest of all, being less prone to 
cause bromism. Its action is slow. 

Diluted hydro bromic acid in its action resembles the bromides, 
though much less depressant than the potassium salt, and less 
likely to occasion symptoms of chronic poisoning. As an acid it is 
a gastric irritant. 

Therapeutics. — Externally and Locally. — Pharyngitis is re- 
lieved by a gargle containing potassium bromide and potassium 
chlorate. A solution of potassium bromide diminishes the sensi- 
bility of the throat, so that examinations are more easily made. A 



198 A TEXT-BOOK OF MATERIA MEDICA. 

solution of 4 parts of potassium bromide in 20 parts of glycerin 
affords a soothing lotion in painful hemorrhoids. 

Internally. — The bromides are especially useful in allaying ex- 
cessive brain activity, the i?isom?iia (particularly the sleeplessness 
dependent upon r :rvous excitement, exhaustion, and irritability) and 
headache of cerebral congestion, yielding readily to these remedies. 

They are undoubtedly the most efficient medicinal agents for 
the relief of epilepsy, being given either alone or in combination 
with some vegetable bitter. Fere combines with them an intestinal 
antiseptic, asserting that the union lessens the tendency of bromism. 
Recent studies of Nencki on the power of potassium bromides to 
replace, in part, sodium chloride in the tissues suggested the idea 
of withdrawal of all salt from the epilectic's dietary and to replace it 
with small quantities of bromide. This permits of complete bromi- 
zation with smaller quantities and is a distinctly useful procedure. 

Being such marked depressants of the reflex centers, they are 
of decided benefit in nervous spasmodic disorders, and particularly 
valuable in infantile convulsions. 

During dentition children suffer from various disturbances due 
to irritation of the dental nerve — co?ividsions, cough, indigestion, 
diarrhea, strabismus, etc. — in all of which the bromides, being power- 
ful depressants of the reflex mechanism, prove of great value. 

Whenever there is increased reflex excitability the bromides are 
indicated. They are therefore valuable in the reflex disturbances of 
the menopause, spasmodic asthma, laryngismus stridulus, whooping 
cough, and other coughs of reflex origin. They have also been used 
in tetanus and strychnine-poisoning. 

Excessive nervous irritability is quickly relieved by these reme- 
dies, either singly or in combination with some of the antispas- 
modics, such as asafetida, valerian, etc. 

Because they depress the sexual mechanism they are of decided 
benefit in spermatorrhea of the plethoric or in the condition arising 
from irritation of the deep urethra. Menorrhagia resulting from 
excessive ovarian excitement is frequently relieved by these agents, 
while nymphomania and delirium tremens are often greatly benefited 
by full doses of the bromides. 

The ammonium bromide has been employed with benefit, it is said, 
in diabetes of nervous origin. Cerebral vomiting and the votniting 
of pregnancy are sometimes singularly amenable to the influence 
of the bromides. 

A combination of sodium bromide, spirit of nitrous ether, and 
tincture of aconite, in anise water, as a remedy in acute febrile 
attacks of children with delirium is of distinct value. Small doses 
are given at frequent intervals until there is a decided improvement 
in the symptoms. 

The sedative action upon the circulatory apparatus exerted by 
potassium bromides renders it valuable in cardiac irritability when 
not due to anemia. It is particularly useful in quieting the heart's 
action in exophthalmic goiter. 



HYPNOTICS. 199 

The bromides are distinctly valuable in combination with chloral 
to relieve chordee and to diminish the tendency to sexual excite- 
ment which is antecedent to this condition. In irritative cystitis the 
bromides are also of service. 

Bromides are useful in the convulsive respiratory disorders, and 
are also helpful in seasickness. 

Diluted hydrobromic acid is used for the same purposes as 
the bromides, some clinicians preferring it to the latter to quiet the 
delirium of simple continued fevers. It is employed extensively to 
relieve the symptoms of cinckonism. 

Bromoform is useful as an antispasmodic in whooping cough, 
but it should be carefully administered, as dangerous collapse, as in 
chloroform poisoning, has been frequently reported. 

Contraindications. — The bromides are contraindicated in con- 
ditions of great debility, anemia, or fatty or weak heart with low 
arterial pressure. 

Administration. — The bromides should be given in solution, 
and when long continued, as in the treatment of epilepsy, they 
should be accompanied by restorative agents. Carbonated waters, 
milk, and aromatic elixir serve as efficient vehicles to disguise the 
taste of these salts. 

Children acquire a remarkable tolerance for the bromides, so 
that large doses may be given them with little danger. 

Bromoform may be dropped into a spoonful of water and admin- 
istered in this simple manner, or it may be dissolved in glycerin. 

The diluted hydrobromic acid should be given in water or syrup. 

THE BELLADONNA GROUP* 

This group contains a series of drugs that present a more or less 
sharp contrast to those just studied. The most important are bella- 
donna, hyoscyamus, and stramonium. They belong to one family 
of plants, the Solanaceo?, and contain active principles — alkaloids — 
that are very closely related. These active principles, moreover, are 
confined closely to this family. These alkaloids all contain a tropin 
nucleus, which is a modified pyridine (a piperidine) to which acid 
groups are attached. The general structure of several members of 
the group may be represented as follows (see page 206) : 

The tropin base is of particular interest as a starting-point from 
which these alkaloids can be synthetically constructed. Hyoscy- 
amine is thought to be isomeric with atropine. Hyoscine (scopo- 
lamine) is closely related, but probably differs slightly. The com- 
position of these and other related alkaloids is still in dispute. 
(Some of these are Duboisine, Mandragorine , Daturine, Atropamine, 
Belladonnine, Bellatr opine, Atroseine, etc.). 

The different plants of this group are : Atropa Belladonna, 
Hyoscyamus nzger, Datura Stramonium, Datura alba, Atropa man- 
dr agora, Scopola carniolica, Scopola japonica, Duboisia myoporoides, 
and Anisodus luridus. Only the more important will be here con- 
sidered. 



200 A TEXT-BOOK OF MATERIA MEDICA. 



H H 

I 

c 



L-L 
C 



H— C C— H H— C\ H y C— H 

H— C— H H— C— H 



H-i 



C— H 

N 



Pyridine. Piperidine. 

By loosening of bonds H appears Methylated and ethylated 

in ring to form — 



H 
i 
C 

H— C H 



H H 



H— C 



H' | II r ° I 

H-C C-C-O-H L /- C -C C-O-H 




I 
N H H 

I 
CH 3 

Methyl-piperidine -f- Ethyl hydroxyl Methyl piperidine + tropic acid = atropine. 

= Tropin. 
By substitution of the ethyl hydroxyl by an 
acid (tropic acid), 



Belladonnae Folia— Belladonnae Foliorum— Bella- 
donna Leaves. U. S. I*. 

Definition. — The dried leaves of Atropa Belladonna L., yielding when assayed 
not less than 0.35 per cent, of mydriatic alkaloids. 

Atropa Belladonna is a nearly glabrous, herbaceous, perennial plant, from 4 to 6 
feet ( 1. 2-1. 8 M.) high, bearing dark-purple, bell-shaped flowers and shining purplish- 
black berries of the size of a cherry. It is found in the woods, chiefly in the moun- 
tainous districts, of Central and Southern Europe, and as far east as Asia Minor, 
Caucasia, and Central Asia. It is cultivated in Europe and in the United States to 
some extent, being known by the common name of "deadly nightshade." 

Description and Properties. — The leaves are from 4 to 6 inches (10-15 Cm.) 
long and about one-half as broad, broadly ovate, equilaterally narrowed into a petiole, 
tapering at the apex, entire on the margin, smooth, thin, the upper surface brownish- 
green, the lower surface grayish-green, both surfaces whitish punctate; odor slight, 
taste bitterish and disagreeable. 

Belladonna leaves contain from 0.2 to 0.6 per cent, of atropine, the most important 
alkaloid, belladonnine (probably anhydro-atropine), besides an alkaloid practically iden- 
tical with hyoscyamine and chrysatropic acid. 

Dose. — 1-5 grains (0.06-0.30 Gm. ) [1 grain (0.065 Gin.), U. S. P.]. 

Official Preparations. 

Extractum Belladonnae Foliorum — Extracti Belladonnae Foliorum — Ex- 
tract of Belladonna Leaves. — Dose, x /%-% grain (0.008-0.048 Gm.) \\ grain 
(0.1 Gm.), U. S. P.], 

Emplastrum Belladonnas (20 per cent. ) — Emplastrum (ace.) Belladonnae — 
Belladonna Plaster. — For external use. Should contain not less than 0.38, nor more 
than 0.42, per cent, of mydriatic alkaloids. 

formula: Extract of belladonna leaves, 300; adhesive plaster, 700. 

Tinctura Belladonnae Foliorum (10 per cent.) — Tincturae Belladonnae Folio- 
rum— Tincture of Belladonna Leaves. — Dose, 5 _ 20 minims (0.3-1. 2 Cc.) [8 minims 
(0.5 Cc. , U.S. P.]. 



HYPNOTICS, 2d 

Unguentum Belladonnae (10 per cent.) — Unguenti Belladonnae — Belladonna 
Ointment. — For external use. 

Formula : Extract of belladonna leaves, io ; diluted alcohol, 5 ; benzoinated lard, 
65 ; hydrous wool fat, 20. 

Belladonnae Radix— Belladonnae Rad cis— Bella- 
donna Root. 77. S. B. 

Description and Properties. — The dried root of Atropa Belladonna, yielding 
when assayed not less than 0.5 per cent, of mydriatic alkaloids. The root occurs in cyl- 
indrical, tapering, longitudinally wrinkled pieces, ]/ 2 to I inch (12-25 Mm.) thick; 
externally brownish-gray, internally whitish ; fracture nearly smooth and mealy, not 
radiating or showing medullary rays in the thicker roots, except in the layer near the 
bark ; nearly inodorous, of sweetish taste, afterward bitterish and strongly acrid. 

The root contains the same constituents as the leaves, with the exception of chrysa- 
tropic acid — which is wanting — and in addition a red coloring-principle, atrosin, found 
also in the berries. Young roots have been found to contain proportionately higher 
percentages of hyoscyamine. The unripe berries contain hyoscyamine, while the proc- 
ess of ripening seems to either convert this alkaloid into atropine or larger quantities 
of atropine are conveyed to the berries at ripening. 

Official Preparations. 

Fluidextractum Belladonnae Radicis — Fluidextracti Belladonnas Radicis — 
Fluidextract of Belladonna Root. — Dose, 1-3 minims (0.06-0.18 Cc.) [1 minim 
(0.05 Cc), U. S. P.]. 

Linimentum Belladonnae (95 per cent.) — Linimenti Belladonnae — Bella- 
donna Liniment. — For external use. 

Formula : Camphor, 50 ; fluidextract of belladonna root, 950. 

Atropina— Atropinae— Atropine. U. S. I*. 

Definition. — An alkaloid obtained from Atropa Belladonna and from other plants 
of the same family. 

Description and Properties. — White acicular crystals, or a more or less 
amorphous white powder, odorless, having a bitter, acrid taste, gradually assuming a 
yellowish tint on exposure to air. As it occurs in commerce, it is usually accompanied 
by a small amount of hyoscyamine. Soluble in 130 parts of water, 3 parts of alcohol, 
16 parts of ether, 4 parts of chloroform, and about 50 parts of glycerin. 

Dose.— jYQ-jij grain (0.0005-0.00 16 Gm. ) [ T i^ grain (0.0004 Gm.), U. S. P.]. 

Official Preparations. 

Atropinae Sulphas — Atropinae Sulphatis — Atropine Sulphate. U. S. P. — 

Description and Properties. — A white, indistinctly crystalline powder, odorless, having 
a very bitter, nauseating taste, permanent in air. Soluble in 0.4 part of water, 6.2 
parts of alcohol, 2270 parts of ether, and 694 parts of chloroform. It is usually min- 
gled with a small amount of hyoscyamine sulphate. 

Dose. — t |o _ to g ram (0.0005-0.0016 Gm. ) [yl^ grain (0.0004 Gm. ), U. S. P.]. 

Oleatum Atropinae — Oleati Atropinal — Oleate of Atropine, U. S. P.— Contain- 
ing 2 per cent, of atropine. 

Homatropinae Hydrobromidum— Homatropinae 
Hydrobromidi— Homatropine Hydrobromide. 

Definition. — The hydrobromide of an alkaloid obtained by the condensation of 
tropine and mandelic acid. 

Atropine may be broken up, by the action of alkalies, into an alkaloid, tropine, 
and an aromatic acid, tropic acid. Tropine forms ester-like compounds with many 
acids ; the compounds with aromatic acids are called tropeins. Homatropine is one 
of these tropeins, formed by the union of tropine and mandelic acid ; the latter is 

phenylglycollic acid C 6 H 5 CH<( C qqtt )• Tropic acid (the acid of atropine) is phe- 



202 A TEXT-BOOK OF MA TERIA MEDICA. 

(CFT OT-T\ 
C 6 H 5 CH<^pqXtt ). Scopolamine (hyoscine) is formed by 

the union of tropic acid with scopoline, a compound similar to tropine. 

Properties. — Small, colorless, odorless, rhombic crystals or crystalline powder, 
having a bitter taste. Soluble in 5.7 parts of water and 32.5 parts of alcohol. It 
should be kept in well-stoppered vials protected from light. 

Dose. — "Average dose: 0.0005 Gm. =0.5 milligramme ( T ^j grain)." U. S. P. 

Euphthalmin is a recently introduced mydriatic, having a physiological action, 
very similar to homatropine ; it is a mandelic acid derivative of beta-eucaine. 

Allied Plants. 

Atropa Mandragora L., Mandrake, closely resembles Atropa Belladonna. It 
possesses marked anesthetic properties, and contains a mydriatic alkaloid. It is espe- 
cially interesting because of its ancient history, its action having been fully described 
by Dioscorides and Pliny. Historians and poets have alike celebrated its peculiar and 
wonderful properties. 

Antagonists and Incompatibles. — Muscarine antagonizes the 
action of belladonna in nearly every particular, and physostigmine, 
pilocarpus, and aconite counteract many of its effects. Opium an- 
tagonizes its action on the cerebrum, pupil, heart, respiration, arterial 
tension, and kidneys. 

Atropine is incompatible with caustic alkalies, tannin, and vege- 
table infusions containing tannin, an insoluble tannate of the alka- 
loid being formed. 

Synergists. — The mydriatic drugs mentioned aid the action 
of belladonna. 

Physiological Action. — The action of belladonna is dependent 
upon the amount of atropine it contains. 

Externally and Locally. — When locally applied atropine is anal- 
gesic, antispasmodic, antisecretory, and mydriatic. When thus 
used, in combination with absorbable substances — such as alcohol, 
camphor, animal fats, glycerin, etc. — it diminishes the sensibility of 
the sensory nerves, and when absorbed from raw surfaces of the 
skin or from the subcutaneous tissue it is capable of producing 
systemic effects. 

Internally. — Digestive Symptom. — Even small doses produce dry- 
ness of the mouth, owing to the greatly diminished secretion of 
saliva and mucus. The salivary secretion is lessened through 
paralysis of the peripheral endings of the secretory fibers only of 
the chorda tympani nerve in the submaxillary gland. 

The drug diminishes the secretions from the stomach, liver, pan- 
creas, and intestines possibly in a similar manner. The sweat is 
diminished through paralysis of the peripheral nerve-endings in the 
sudoriparous glands. The secretion of milk is reduced by paralysis 
of the peripheral terminations of the secretory nerves in the mam- 
mary glands. The secretion from the bronchial mucous membranes 
is lessened through the depressing influence of the drug upon the 
nerve-endings. The secretions of the kidneys are not as profoundly 
altered as are other glandular products. 

Atropine is absorbed readily. It breaks up into tropin and 
tropic acid and has a marked action on the nervous structures. 



HYPNOTICS. 203 

Unstriped Muscles. — The peristaltic movements of the intestines 
are generally decreased by atropine. Very large doses are known 
at times to cause violent peristalsis and thus are thought to be of 
value in intussusception. 

Nervous System. — A full medicinal dose of belladonna stimulates 
the brain, while large doses — and, in susceptible persons, medicinal 
ones — may produce hallucinations and delirium, accompanied by 
spectral illusions. The delirium may be mild, joyful, and talkative, 
or it may assume a violent type. It may, moreover, persist for a 
long time, after which the patient sinks to sleep, induced either by 
exhaustion from the delirium or a secondary depressing action of 
the drug. The motor area is also stimulated. 

The spinal cord shares in the stimulation caused by belladonna. 
The reflexes are at first slightly exaggerated, being afterward 
diminished. Very often under poisonous doses there is complete 
motor paralysis, the loss of power occurring first in the lower 
extremities. 

The sensory nerves are depressed, especially when the drug is 
locally applied, the influence being exerted on their terminal fila- 
ments. 

Respiratory System. — Medicinal doses quicken and deepen the 
respirations, owing to stimulation of the respiratory center. 

Poisonous doses over-stimulate, and consequently exhaust or 
paralyze, the respiratory center, the result being slow and shallow 
breathing and death from asphyxia. 

Circulatory System. — Medicinal doses of atropine or belladonna 
at first retard the pulse, due, it is thought, to a stimulation of the 
vagus centers, thus inhibiting the action, but it is quickly accelerated 
and rendered firmer with increased arterial pressure. The primary 
transitory action is due to a slight stimulation of the vagi roots, the 
subsequent quickening of the pulse resulting from paralysis of the 
peripheral ends of the pneumogastric nerve distributed in the car- 
diac muscle. The inhibition being thus removed, the heart re- 
sponds to the influence of the accelerator nerves. The center for 
these nerves in the medulla is also stimulated by the drug, increas- 
ing still further the rapidity of the heart's action. The cardiac 
muscle itself, being stimulated, renders the contractions of the heart 
more forcible. 

Arterial tension is increased not only by the greater rapidity 
and force of the heart, but also by the contraction of the arterioles 
arising from stimulation of the vasomotor center. Very large or 
poisonous doses lower arterial pressure. This effect is produced 
by exhaustion of the vasomotor center from over-stimulation, 
resulting in dilatation of the cutaneous arterioles, which lowers 
arterial tension and flushes the skin. Overwhelming doses may 
weaken the cardiac muscle itself from over-stimulation, weakening 
the heart's contraction, as well as paralyzing the terminal nerve- 
filaments in the muscles of the vessel-walls, and even the muscular 
fibers 



204 A TEXT-BOOK OF MA TERIA MEDICA. 

Absorptioii and Elimination. — Atropine is rapidly absorbed and 
eliminated, chiefly by the kidneys, but also to some extent by the 
bowels. It is thought that part of the drug is oxidized by the liver. 

Temperature. — Large doses slightly increase bodily heat, proba- 
bly by increasing the circulation and respiration, consequently aug- 
menting combustion. Ott maintains that belladonna stimulates 
the heat-center. In cases of severe poisoning from the drug the 
temperature rapidly falls. 

Eye. — Belladonna dilates the pupil, whether locally applied or 
taken internally. The manner in which atropine dilates the pupil 
has not yet been satisfactorily explained, the prevailing opinion being 
that the action is due to a paralysis of the peripheral ends of the 
oculomotor nerves. The dilatation may be rendered greater by 
stimulation of the cervical sympathetic, but the fully dilated pupil 
is irresponsive to light and accommodation. 

Atropine increases intraocular tension, rendering it a dangerous 
drug in glaucomatous conditions. 

Untoward Action. — Very frequently there appears, especially in 
children, an erythematous or scarlatinal eruption, oftener noticeable 
on the face and neck, but sometimes affecting the entire surface of 
the body. Redness and pain in the throat may also be present, but 
no fever, with itching of the skin or desquamation. 

Occasionally instillation of atropine into the eye produces pro- 
fuse lacrimation, edema of the eyelids, and blepharo-conjunctival 
irritation. 

When taken internally in medicinal doses it sometimes occasions 
in certain persons vertigo, turgescence of the face, hallucinations, 
erethistic debility, and impaired assimilation. 

Homatropine has caused dizziness, uncertainty of gait, fatigue, 
difficulty in deglutition, and loquacious delirium. 

Poisoning. — The poisonous actions of belladonna may be sum- 
marized as follows : 

The skin is dry and hot ; the conjunctivae are congested, with, 
possibly, edema of the eyelids, and pupils widely dilated ; the heart 
action becomes rapid after ten to fifteen minutes ; the face is swollen, 
while the whole body may be covered with an erythematous rash, 
and there is a sensation of heat and pain in the throat and difficulty 
in swallowing. These symptoms usually develop in from fifteen to 
twenty minutes. 

Rapid respirations, muscular weakness, and incoordination of 
movements appear; the patient becomes dizzy or mildly or violently 
delirious, continually talking, shouting, or laughing. While there 
is a constant desire to micturate, there is an inability to pass any 
urine. At this stage the respirations are slow and shallow. Finally, 
convulsions may occur, and the patient sink into a comatose con- 
dition and die from asphyxia and cardiac exhaustion. 

A lethal dose of atropine has been for an adult 0.15 gm. (2.5 
grs.) and for a three-year-old child 0.01 gm. (-J- gr.). The mortality 
is not high, being stated by Kionka to be about 1 1.6 per cent. This 



HYPNOTICS. 205 

was the figure of Feddersen in his dissertation study (Berlin) of 103 
reported cases from 1880 to 1882. It is of interest to note that a 
fatal case is reported from the application of a plaster containing 
0.18 gm. of atropine to 8 gm. fat (3 gr.). In fatal cases death takes 
place in from six to eight hours, sometimes as late as eighteen to 
twenty hours. 

Treatment of Poisoning. — Wash out the stomach with solutions of 
tannic acid, pursuing the treatment with the cautious administration 
of physostigmine, morphine, or small doses of pilocarpine. Should 
cardiac failure be pronounced or the patient lapse into a state of 
stupor, stimulants and the subcutaneous injection of caffeine are 
indicated, the patient being aroused meanwhile and kept awake, if 
possible, respiration being maintained by the use of strychnine and 
by artificial means when necessary. Should the temperature fall 
below normal, external heat must be applied. It is usually advisable 
to empty the bladder by means of a catheter. 

Atropine Compared with Morphine. 

Atropine stimulates respiration ; morphine is a powerful respi- 
ratory depressant. Atropine dilates the pupil ; morphine contracts 
it. Atropine increases bodily heat, and frequently reddens the 
surface of the skin ; morphine produces pallor of the skin and 
lowers temperature. 

Both drugs lessen peristaltic action of the bowels in moderate 
doses. Atropine reinforces the functional activity of the kidneys ; 
morphine lessens it. On the other hand, atropine checks the 
secretion from the skin, while morphine increases it. 

The remaining secretions are diminished by both drugs, but in 
different ways. 

Atropine acts" rather as a cerebral excitant, producing delirium, 
hallucinations, and disturbed sleep ; morphine is more of a cerebral 
depressant, the period of mental excitation being comparatively 
brief, while sleep is longer and more profound. 

In many respects these drugs are mutually synergistic. Both 
relieve pain, though morphine is much the more powerful anodyne. 
Both cause incoordination of muscular movements and mental con- 
fusion. 

Although in many respects antagonistic, they are frequently 
combined when an anodyne action is desired. As has been forcibly 
suggested, their reciprocal influence, when administered together, 
modifies in a remarkable manner their physiological effects. 

Therapeutics. — The many uses for which belladonna has been 
employed would render it a difficult, perhaps useless, task to 
enumerate them. As in the case of opium, there are certain 
general and important actions in disease which the physican 
can utilize in daily practice, a succinct mention of which is 
appended : 

1. Belladonna is serviceable in relaxing spasms of invol- 



206 A TEXT-BOOK OF MA TERIA MEDICA. 

untary muscles, as in asthma, spasmodic colic, lead colic, spasmodic 
dysmenorrhea, laryngismus stridtilus, etc. 

2. In diminishing secretion, as in acute coryza, bronchitis, night- 
sweats of phthisis, and to check the secretion of milk, mercurial 
ptyalism, etc. 

3. In relieving pain, either combined with opium or morphine, 
or alone, particularly where it can be applied locally, as in lumbago, 
neuralgia, pleurodynia, etc. 

4. Belladonna is used to stimulate the circulatory system 
in cases of a weak heart and low arterial tension, as in fevers, etc. 

5. For ITS PECULIAR ACTION UPON THE EYE IN OPHTHALMOLOGI- 

cal practice, to dilate the pupil, prevent adhesion, remove con- 
gestion, relieve pain, and afford rest. 

While, as has been said, it is impossible to discuss in detail the 
manifold uses of belladonna, its more important therapeutic services 
may be here mentioned : 

Externally and Locally. — Belladonna ointment is useful in the 
treatment of boils, carbuncles, chronic i7iflammatory co?zditio?is about 
the articidations, chronic synovitis of the knee-joint, its efficiency in 
the latter condition being enhanced by combining it with mercurial 
ointment. Orchitis is greatly relieved by covering the testicle with 
belladonna ointment. Suppositories containing extract of bella- 
donna are beneficial .in the treatment of Jiemorrhoids, and in anal 
fissure. 

Eczema and excessive sweating of certain areas of the skin, such 
as the palms and soles, are benefited by a local application of the 
tincture or the dried and powdered extract mixed with some inert 
desiccant powder like powdered talcum. 

Belladonna plaster is one of the most useful applications in cases 
of acute or chronic muscular rheumatic pains, and in forms of 
neuralgia. In its power to arrest the secretion of milk the drug is 
perhaps without an equal. 

Internally. — Belladonna is combined with opium to relieve the 
pain of gastralgia and enter algia, while its combination with strych- 
nine and iron is useful in anemic 7ieuralgia. 

Nocturnal incontinence of urine in children, when resulting from 
supersensitiveness of the mucous membrane of the bladder, derives 
signal benefit from the drug. 

Belladonna combined with strychnine stimulates the respiration 
and checks the sweating in phthisis. A similar union with some 
laxative drug makes an exceedingly useful pill in habitual consti- 
pation, while the obstinate constipation due to lead-poisoning 'is greatly 
relieved by belladonna. 

This drug, as well as the other mydriatic narcotics, is one of the 
most reliable remedies we possess to relieve the symptoms of spas- 
modic asthma. It is highly recommended also by many physicians 
in typhoid fever to support the circulation and relieve many dis- 
tressing symptions of the disease. In scarlatina, too, it is thought 
to be a useful remedy. It is useful in whooping-cough. 



HYPNOTICS. 207 

Cardiac pain and distress due to over-action of the heart are 
alleviated by the application of belladonna plaster over the cardiac 
region or by the internal use of the drug. 

Intestinal \ hepatic, and renal colic, cystitis, prostatitis, spermator- 
rhea, exophthalmic goiter, cerebral 'and spinal hyperemia, sea-sickness , 
facial erysipelas, and me?iorrhagia have all apparently been favorably 
influenced by belladonna. 

Atropine subcutaneously injected is a powerful antidote to chlo- 
roform-, physostigma-, morphine-, aconite-, and jaborandi-poisoning, 
as well as that contracted from muscarine or phallin containing 
mushrooms. 

Administration. — The crude drug, leaves, and root are seldom if 
ever used. Owing to its action in diminishing secretion, it is better 
to time the internal adminstration of belladonna so as to interfere 
as little as possible with the process of digestion. 

Children are peculiarly insusceptible to this drug, sometimes 
tolerating as large doses as adults. 

When atropine is used hypodermically in cases of sciatica or 
neuralgia, the injection should be made deeply in close proximity 
to the affected nerve-trunk. 

The part of the body to which a belladonna plaster is to be 
applied should be first thoroughly cleansed and dried, the exact 
area to be covered being specifically designated by the physician. 
Caution should be exercised in the application, lest too large a 
space be covered by the plaster, and dangerous symptoms super- 
vene from absorption of its more active constituents, a result which 
may also occur from too prolonged contact, from three to five days 
being usually sufficient. Should it be desirable to continue the 
influence of the drug, the application of fresh plaster from time to 
time will produce better results than too long use of a single one. 



Hyoscyamus— Hyoscyami— Hyoscyamus. TJ. S. P. 

(Henbane.) 

Origin. — The dried leaves and flowering tops of Hyoscyamus niger L., collected 
from plants of the second year's growth, and yielding, when assayed, not less than .08 
per cent, of mydriatic alkaloids. Henbane is a biennial growing in sandy soil and 
waste places throughout the greater portion of Europe and Asia, and naturalized in 
North America. 

Description and Properties. — Leaves ovate or obovate-oblong, up to 10 
inches (25 Cm. ) long and 4 inches ( 10 Cm. ) broad ; sinuate-toothed, the teeth large, 
oblong, or triangular ; grayish green, and, particularly on the lower surface, glandular- 
hairy ; midrib prominent ; flowers nearly sessile, with an urn-shaped, five-toothed 
calyx and a light-yellow, purple- veined corolla ; odor heavy, narcotic ; taste bitter and 
somewhat acrid. 

The active constituents are hyoscyamine and hydscine (scopolamine), and a very 
poisonous volatile oil is obtained by distillation of the leaves, which contain also a 
small percentage of potassium nitrate. It is important to bear in mind that the modern 
hyoscyamine is distinct from the impure mixture of hyoscine and hyoscyamine pre- 
viously designated hyoscyamines. 

Dose of the Leaves. — 5-15 grains (0.3-1.0 Gm. ) [4 grains (.250 Gm.), 
U. S. P.]. 



2o8 A TEXT-BOOK OF MA TERIA MEDICA. 

Official Preparations. 

Extractum Hyoscyami — Extracti Hyoscyami — Extract of Hyoscyamus.— 

Dose, 1-3 grains (0.06-0.2 Gm.) [1 grain (.065 Gm. ), U. S. P.]. 

Fluidextractum Hyoscyami — Fluidextracti Hyoscyami — Fluidextract of 
Hyoscyamus. — Dose, 5-15 minims (0.3-1.0 Cc.) [3 minims (1 Cc), U. S. P.]. 

Tinctura Hyoscyami — Tincturae Hyoscyami — Tincture of Hyoscyamus 
(10 per cent.). — Dose, 10-60 minims 10.6—4.0 Cc. ) [30 minims (2 Cc), U. S. P.]. 

Hyoscinae Hydrobromidum — Hyoscinae Hydrobromidi — Hyoscine Hydro- 
bromide (U. S. P.). — Origin. — The hydrobromide of an alkaloid, chemically identical 
with scopolamine, obtained from hyoscyamus and other plants of the Solanacece. 

Description and Properties. — Colorless, transparent, rhombic crystals, odorless, and 
having an acrid, slightly bitter taste; permanent in the air. Soluble in 1.5 parts of 
water and in 16 parts of alcohol at 25 C. It should be kept in small, well-stoppered 
vials. 

Dose. — 1 qo ~ 6 1 o g ram f 0.0006-0. 00 1 Gm. ) [ T ^-g- grain (.0005 Gm.), U. S. P.]. 

Hyoscyaminae Hydrobromidum — Hyoscyaminae Hydrobromidi — Hyoscya- 
mine Hydrobromide (U. S. P.). — Origin. — The hydrobromide of an alkaloid ob- 
tained from hyoscyamus and other plants of the Solanacece. 

Description and Properties. — Yellowish-white, amorphous, resin-like masses or 
prismatic crystals, having, particularly when damp, a tobacco-like odor and an acrid, 
nauseous, and bitter taste. Deliquescent on exposure to the air ; soluble in about 0.3 
part of water and 2 parts of alcohol. It should be kept in small, well-stoppered vials. 

Dose. — T ^o _ io § ram (0.0006-0.0015 Gm.) [ T ± y grain (.0005 Gm. ), U. S. P.]. 

Hyoscyaminae Sulphas — Hyoscyaminae Sulphatis^ — Hyoscyamine Sul- 
phate (U. S. P.). — Origin. — The neutral sulphate of an alkaloid obtained from hyos- 
cyamus and other plants of the Solanacece. 

Description and Properties. — White, indistinct crystals or a white powder, without 
odor, and of a bitter, acrid taste ; deliquescent in damp air. Soluble in 0.5 part of 
water and 6.4 parts of alcohol at 25 C. ■ It should be kept in small, well-stoppered 
bottles. 

Dose. — i^q-^V grain (0.0006-0.0015 Gm.) [ T ij grain (.0005 Gm.), U. S. P.]. 



Scopola— Scopolae— Scopola. TJ. S. JP. 

Definition. — The dried rhizome of Scopola Carniolica, Jacquin. Scopola is 
closely related to belladonna and hyoscyamus. 

The Pharmacopoeia demands that the drug contain not less than 0.5 per cent, of 
alkaloids ; it is assayed by the same process as are belladonna leaves. 

Dose. — Average dose: 0.045 Gm. =45 milligrammes (^ grain). U. S. P. 

The alkaloid of scopola is almost wholly hyoscine. The content of the alkaloids 
of scopola is remarkably uniform (about 0.55 per cent.), whereas the percentage of 
alkaloids in belladonna varies from 0.2 to above 1 per cent. 

Official Preparations. 

Scopolamine Hydrobromidum — Scopolaminae Hydrobromid — Scopolamine 
Hydrobromide. U. S. P. — Definition. — The hydrobromide of an alkaloid, C 1T 1 1 21 - 
N0 4 HBr — 3H 2 0, obtained from plants of the Solanacece; chemically identical with 
hyoscine hydrobromide. 

Although hyoscine hydrobromide, which was admitted into the U. S. Pharmacopoeia, 
1890, and scopolamine hydrobromide are identical, both names are used in the U. S. 
Pharmaco] oeia, Eighth Decennial Revision, as separate headings, because physicians are 
more familiar with the name hyoscine than with scopolamine. Scopolamine is formed 
by the union of tropic acid and scopoline, a compound similar to tropine. (See Ilcma- 
tropine. ) 

Dose. — Average dose : T \^ grain (0.0005 Gm.=0.5 milligramme). U. S. P. 

Extractum Scopolae — Extracti Scopolae — Extract of Scopola. (U. S. P.). — 
The I . S. Pharmacopoeia demands that the extract of scopola contain 2 per cent, of 
mydriatic alkaloids ; for method of assay see Pharmacopoeia. 

Dose. — Average do-e : 1 grain 0.010 Gm. = 10 milligrammes), U. S. P. 



HYPNOTICS. 209 

Fluidextractum Scopolae — Fluidextracti Scopolae— Fluidextract of Scopola 
(U. S. P.). — Prepared from scopola (q. v. ) and containing 0.5 per cent, of the mydriatic 
alkaloids of this drug. 

Dose.— Average dose :' 1 minim (0.05 Cc), U. S. P. This dose contains ^ grain 
(0.00025 gram) of the scopola alkaloids. 

Physiological Action. — The action of hyoscyamine is analogous 

to that of belladonna, with the following difference: (i) It shows 
more cerebral depression, as a rule, than does atropine. Excite- 
ment is, however, by no means infrequent. 

(2) Pure hyoscyamine is thought to be more powerful than 
atropine (2 to 1), and exhibits its antisecretory and other effects 
more promptly. 

As for hyoscine (scopolamine), the action is quite different. 
Hyoscine is a distinct hypnotic. It depresses the cerebrum. Whether 
this depression is analogous to the depression of atropine with a 
very slight or no preliminary stimulation is not yet known. It is 
not improbable that hyoscine may be regarded as causing a more 
profound coma with less of the other effects of atropine. In its 
action on the peripheral nervous system it very closely resembles 
atropine in its action, being perhaps more powerful. Profound col- 
lapse has occurred from its use in disease with rapid and feeble 
pulse. The action in the medulla does not seem to be as stimu- 
lating as is that of atropine. 

Untoivard action, poisoning, and treatment of poisoyiing are the 
same as for belladonna. 

Therapeutics. — Hyoscyamus may be used for the same pur- 
poses as belladonna, but is considered superior to the latter drug as 
a urinary sedative in the treatment of incontinence of urine, vesical 
tenesmus, cystitis, prostatitis, etc. 

For the relief of colic of various forms, and to allay the giiping 
produced by certain purgatives, hyoscyamus is better than bella- 
donna. 

In mental disorders it is useful in any maniacal state. In con- 
vulsive disorders, hysterical convulsio?is, chorea, paralysis agitans, etc., 
hyoscyamus, particularly hyoscine, is superior to belladonna. 

Hyoscyamus and its alkaloids are fully equal to belladonna in 
the treatment of asthma, wlwoping cough, neuralgia, eiitcralgia, etc. 

As an anodyne and hypnotic for children hyoscyamus is fre- 
quently used. Scopolamine and morphine in combination are use- 
ful for producing surgical anesthesia. 

Administration. — Like belladonna, this drug should be admin- 
istered tentatively. Any of the preparations may be given. The 
salts of the alkaloids may be administered either subcutanously or 
internally. 

The hyoscine is tasteless, and may be easily given in various 
drinks. When used internally its action is slower, but more pro- 
longed, than when given hypodermically, though the dose under 
the former method should be twice that of the latter. 



2IO A TEXT- BO OK OF MATERIA MEDIC A. 

Stramonium— Stramonii— Stramonium. TJ. S. P. 

(Thorn-apple; Jamestown or Jimson Weed.) 

Definition. — The dried leaves of Datura Stramoniu?n L., yielding when assayed 
not less than 0.35 per cent, of mydriatic alkaloids. Stramonium is a coarse-looking 
annual weed, believed to be a native of Asia, but found growing in waste places and 
along roadsides throughout the greater part of the world. 

Description and Properties. — From 3 to 8 inches (7-20 Cm.) long, petio- 
late, dark-green, smooth, ovate, pointed, unequal, especially at the base, coarsely and 
sinuately toothed ; thin, brittle, and nearly inodorous ; taste unpleasant, bitter, and 
nauseous. Stramonium leaves contain about 0.2 per cent, of a mixture of atropine and 
hyoscyamine previously termed ciaturine. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Antagonists, incompatibles, and synergists are the same as 
for belladonna. 

Physiological Action. — The action of stramonium is practically 
identical with that of belladonna. It is thought to contain larger 
amounts of hyoscyamine than belladonna, and will, therefore, have 
more of the action of that drug combined with the action of atro- 
pine. 

Poisoning from the thorn apple is by no means uncommon. It 
is a ubiquitous weed, widely dispersed, and its seeds are frequently 
eaten by children. The treatment should follow the lines established 
for belladonna-poisoning. 

Therapeutics. — The medical uses of belladonna are applicable 
to this drug, although stramonium is much more widely used in 
spasmodic asthma. 

Administration. — No special directions are necessary, any of 
the preparations being serviceable. For asthma the leaves may be 
smoked in a pipe or in the form of cigarettes, this method of em- 
ploying the drug to relieve bronchial spasm being probably superior 
to internal administration. 

COCA. 

Closely allied both chemically and pharmacodynamically with 
the preceding group is the alkaloid of the Peruvian coca plant. 

Erythroxylon Coca. — Students frequently confuse this drug with 
the cacao, that gives the widely used drink cacao and chocolate, 
the Theobroma cacao. Needless to say they are widely separated 
products. The active principle of Erythroxylon is cocaine, also a 
tropein derivative. It is also supposed to be a methyl piperidine. 
Its structural formula reveals a close relationship to that of atropine 
(see p. 201). 



" 






C 6 H 6 
II 



c 1 [_c ( :_ c— c— o— ch 3 



I I 

II II o 



I 

Methyl piperidine. 



HYPNOTICS. 2ii 

Many synthetic modifications of cocaine are naturally possible, 
as has already been pointed out in the section on Atropine, and a 
large number of related bodies have been manufactured. Nature 
herself has made a number of aromatic compounds of cocaine. Eu- 
caine and /?-eucaine are two of the newer synthetic combinations. 

Coca— Cocae— Coca.— U. S. -P. 

Origin. — The dried leaves of Erythroxylon Coca Lam., known commercially as 
Huanuco Coca or of E. Truxillense, Rusby, known commercially as Truxillo Coca, 
yielding when assayed not less than 0.5 per cent, of the ether-soluble alkaloids of coca. 

Coca is indigenous in the mountains of Peru and Bolivia, and on the eastern slopes 
of the Andes, is cultivated in damp, warm valleys from 3000 to 6000 feet (914. 5-1829 M.) 
above the sea-level, being also grown in some parts of. Colombia, Brazil, the Argentine 
Republic, and the island of Java. The province of La Paz in Bolivia produces the 
largest crops, the article being more highly esteemed than the Peruvian variety. 
Cocaine is obtained from leaves of several varieties of Erythroxylon. 

The active constituent is the alkaloid cocaine, 0.36 to 1.67 percent. The plant 
also contains a number of allied alkaloids, cinnamyl cocaine, cocamine, isococamine, 
tropacocaine, hygrine, etc. These are all found in minute quantities. 

Dose. — \-\ drachms (2.0-16.0 Gm. ) [30 grains (2 Gm.), U. S. P.]. 

Official Preparations. 

Fluidextractum Cocae — Fluidextracti Cocae — Fluidextract of Coca. — Dose, 
20 minims-i fluidrachm (1.2-4.0 Cc.) [30 minims (2 Cc. ), U. S. P.]. 

Vinum Cocae — Vini Cocae —Wine of Coca. (U. S. P.). — An official wine pre- 
pared from the fluidextract of coca. 

Dose. — Average dose: 4 fluidrachms (16 Cc. ). U. S. P. 

Cocaina— Cocainae— Cocaine. 

Definition.— An alkaloid [C 8 H 13 (C 6 H 5 CO)NO.COOCH 3 ] obtained from several 
varieties of coca. 

Description and Properties.— Slightly soluble in water (1 : 600), much' 
more so in alcohol (1 : 5), more readily in both when warm ; insoluble in glycerin. 

Cocaine is a methyl compound of benzoylecgonine. When it is boiled with water 
methyl alcohol is first split off, then benzoic acid ; these changes occur more rapidly 
with dilute acids or barium hydroxide. Conversely cocaine may be built up by intro- 
ducing the methyl and benzoyl groups into ecgonine (a compound having the empirical 
formula, C 9 H 15 N0 3 ). 

Dose. — "Average dose: 0.030 Gm. = 30 milligrammes (J grain)." U. S. P. 

Official Preparation. 

Oleatum Cocainae— Oleati Cocainae— Oleate of Cocaine.— Containing 5 per 
cent, of cocaine. 

Cocainae Hydrochloridum— Cocainae Hydrochloridi 
—Cocaine Hydrochloride. U. S. JP. 

Definition. — The neutral hydrochloride of the alkaloid cocaine. 

Description and Properties. — Colorless, transparent crystals or a white, 
crystalline powder, odorless, of a saline, slightly bitter taste, and producing upon the 
tongue a tingling sensation followed by numbness of some minutes' duration. Perma- 
nent in air, soluble in 0.4 part of water and 2.6 parts of alcohol at 25 C; very soluble 
in boiling water and in boiling alcohol. 

Dose. — 1-2 grains (0.008-0. 12 Gm.) [| grain (0.3 Gm.), U. S. P.]. 

Antagonists and Incompatibles. — Morphine, chloral, amyl- 
nitrite, alcohol, chloroform, and ether are physiological antagonists. 
The most direct opponents are chloral and morphine. 



212 A TEXT-BOOK OF MATERIA MEDICA. 

Cocaine is incompatible with caustic alkalies and the alkaline 
carbonates and bicarbonates, as well as with bichloride of mercury, 
iodine and the iodides, ammonia, zinc chloride, and borax. 

Synergists. — Medicinally, its cerebral effects may be enhanced 
by the cerebral stimulants, such as alcohol, cannabis Indica, and 
belladonna, while its analgesic and anesthetic action may be aided 
by carbolic acid, atropine, opium, and conium. When used as a 
mydriatic, atropine serves as a valuable synergist. 

Physiological Action. — For our first knowledge of the physio- 
logical properties of coca we are indebted to its empirical use 
among the natives of Peru. The history of the drug is replete 
with interest and romance. It was regarded as the living repre- 
sentation of the Deity, the ground whereon it grew being held 
sacred. During the reign of the Incas its use was a royal privi- 
lege, the people being compelled to obtain permission from the 
governor to avail themselves of its benefits. Later it was adopted 
indiscriminately. 

The native coqueros (coca-chewers) have learned from experi- 
ence that they can climb the Andes, work laboriously in the mines, 
and endure fatigue and hunger more hardily when chewing the 
leaves of the plant, and from time immemorial the drug has been 
recognized by observers as possessing powerful nutritive, stimulant, 
and restorative properties. 

In describing the action of the crude drug the author can add 
little to the words of Linnseus, who long ago wrote that coca pos- 
sessed " the penetrating aroma of vegetable stimulants, the astricting 
and fortifying virtues of an astringent, the antispasmodic qualities 
of bitters, and the mucilaginous nutritive properties of analeptics or 
of alimentary plants." " This leaf," he adds, " exhibits with energy 
its action on all parts of the animal economy." 

Since the isolation of the alkaloid cocaine, to which the drug 
owes its physiological and medical properties, by Gaedeke in 1855, 
and the subsequent study of it by eminent pharmacologists and 
therapeutists, we have learned more of the physiological action 
of coca. Its effect upon different systems are here described in 
detail. 

Externally and Locally. — Cocaine is anagelsic, anesthetic, and 
ischemic. Upon the unbroken skin it has no action, but upon 
mucous membranes or the subcutaneous tissue it produces com- 
plete local analgesia. The surface to which it is applied becomes 
paler than normal, owing to contraction of the blood-vessels, but 
afterward reddens and appears turgescent through secondary dila- 
tation of the vessels. The absorption of the drug by mucous 
membranes varies with the locality to which it is applied — with 
difficulty from the conjunctiva, yet with great readiness from the 
Schneiderian membrane, producing its characterisic constitutional 
effect. 

Applied to the conjunctiva, or even taken internally, cocaine 
causes a transitory contraction of the pupil, soon followed by dila- 



HYPNOTICS. 213 

tation. The accommodation is impaired, but not completely de- 
stroyed. The ocular tension is lowered. The light reflex is not 
abolished. There may be a slight exophthalmos. 

The analgesic action of cocaine applied locally is due to the de- 
pression of the ends of the nerves of pain-sensation. It does not 
affect the ordinary sensations of touch or temperature to anything 
like the extent that it affects pain-sensation. It dilates the pupil by 
stimulating the ends of the sympathetic nerve, which innervates 
the radiating fibers of the iris. 

In addition to its local analgesic action the drug possesses the 
power of destroying the functions of the nerves of special sense, so 
taste and smell are abolished. When applied locally or taken 
internally it primarily checks many of the secretions, though those 
from the pancreas and liver seem to be uninfluenced by its internal 
use. The secondary impression of cocaine, however, when the 
blood-vessels become dilated, is accompanied by increased secre- 
tions. 

Internally — Digestive System. — Although it has been shown by 
experiments upon animals that cocaine is incapable of sustaining 
life, it diminishes in man the sensation of hunger, owing to its local 
anesthetic action upon the mucous membrane of the stomach, so 
that the coqueros and the modern habitues are able to abstain from 
food for days, thirst also being allayed. This diminution of hunger 
does not seem to impair appetite and digestion until habitual cocaine 
mania destroys the gastric functions almost entirely. This con- 
tributes to the great emaciation of these patients. 

On account of its stimulant action upon the constrictor fibers 
of the great sympathetic nerve, under the influence of moderate doses 
peristalsis is largely increased in the stomach and intestines, very 
large or poisonous doses, on the contrary, causing great sluggish- 
ness of the bowels. 

Nervous System. — When given internally its first action is upon 
the cerebrum, moderate doses greatly stimulating the intellectual 
faculties and producing a feeling of ecstacy and well-being, in many 
respects akin to the sensations experienced under the action of 
cannabis Indica. In the course of a few hours the stage of cerebral 
excitement is succeeded by mental, moral, and muscular depression. 
The motor cortex is also stimulated, causing increased muscular 
excitement or restlessness. Garrulousness is usual. 

Large doses result in incoherent speech and wild delirium, 
accompanied by swaying of the head, followed by epileptiform con- 
vulsions and narcosis. The convulsions are partly of cerebral or 
of basal ganglionic origin. There is a distinct increase in the ability 
to carry on mental labor. 

The medulla is markedly stimulated where a distinct action on 
the centers of breathing and of circulation is manifested. 

Respiratory System. — Medicinal doses powerfully stimulate the 
respiratory center, increasing the rapidity and depth of the respira- 
tions. Poisonous doses paralyze the center, the result being dysp- 



214 A TEXT-BOOK OF MATERIA MEDICA. 

nea, slower, feeble breathing, and death from respiratory failure, 
usually ushered in by convulsions, and often Cheyne-Stokes rhythm. 

Circulatory System. — Medicinal doses of cocaine increase the 
force and frequency of the cardiac contractions, and also arterial 
pressure. Large or poisonous doses render the pulse slow, soft, 
and weak and lower arterial tension. The exact modus operandi is 
not fully determined, but there is direct stimulation of the heart or 
its accelerator mechanism. There is a marked rise in blood-pressure 
due to the cardiac stimulation and to a marked contraction of the 
blood-vessels from vasoconstrictor stimulation. 

The sensory nerves are depressed by small and paralyzed by 
lethal doses. The motor nerves are also depressed by large doses, 
this action, however, being subordinate to that exerted upon the 
sensory nerves. The muscles are stimulated by medicinal doses 
through impression upon the motor tracts, although large doses 
greatly depress muscular activity. The chewing of coca, as prac- 
tised by the natives of Peru and Bolivia, undoubtedly appears to 
augment muscular strength and powers of endurance. 

Mosso claims that small doses of cocaine serve as a powerful 
muscular stimulant in cases of exhaustion from hunger or fatigue. 
The analgesia produced is largely responsible for the sense of 
muscular power. Tire is not felt as its physiological accompani- 
ment pain. 

Absorption and Elimination. — Cocaine is quickly absorbed, being 
eliminated principally by the kidneys in a form differing from its 
original nature. Much of it probably undergoes oxidation in the 
body. The amount of urine is increased, though the nitrogenous 
elements are diminished. The habitual use of the drug lessens 
urinary secretion. 

Cocaine possesses no cumulative action. Metabolism is slightly 
increased by the augmented muscular activities, but the exact rela- 
tions of cocaine to metabolism are not yet available. 

Temperature. — Medicinal doses have no influence on bodily 
heat, but poisonous doses usually raise the temperature, owing, 
according to Reichert, to an increase of heat-production. 

Eye. — Cocaine produces a noticeable dilatation of the pupil, as 
already explained under " Local Action," the maximum change 
being reached in about an hour, and the normal state regained in 
from twelve to twenty-four hours. 

Cocaine-poisoning. — Among the most prominent physiological 
symptoms resulting from the ingestion of excessive doses of co- 
caine or repeated and continued injections are a tendency to coma 
or collapse; a feeble, thready pulse, often running extremely high ; 
great emaciation ; anorexia and impairment of the digestive powers, 
and increased frequency, and, again, alarming depression of respira- 
tion. There are other systems, scarcely less serious, which, as 
the majority of observations show, render cocaine one of the most 
generally deleterious of drugs, opium not- excepted. Dropsy, ma- 
rasmus, numbness, syncope, profound malaise, muscular twitchings 



HYPNOTICS. 215 

with mild convulsions, insomnia, amblyopia, mydriasis, visual hal- 
lucinations, headache, vertigo, dangerously elevated temperature, 
dental decay, and fetid breath — even this admonitory catalogue of 
ills fails to complete the recorded phenomena attending chronic 
poisoning from cocaine. 

Yet, grave as are the foregoing physical changes incident to an 
immoderate use of the drug, the mental and, above all, the moral 
effects of cocaine-poisoning are far more deplorable. It is a melan- 
choly but indubitable fact that to one fully committed to the so- 
called " cocaine habit " there appears at times no principle of honor 
or decorum to which the vitiated sensibilities are amenable. The 
enfeeblement of the intellectual faculties, the loss of memory, inabil- 
ity to coordinate or control ideas, a consciousness occasionally 
merged in pronounced mania, possibly with homicidal inclination, 
and an intense selfishness of thought and purpose, in which apathy, 
neglect of domestic obligations, and complete debasement of nobler 
qualities are developed — these lamentable accompaniments manifest 
too clearly the degenerating influences exerted by a constant resort 
to the use of this ill-fated, if not fatal, drug. 

It frequently happens that cocainism arises from a desire to 
relieve effects produced by the immoderate use of opium. Yet the 
latter drug, being taken to offset the influence of cocaine, in reality 
but aggravates the evil, the two agents interacting and still further 
lessening the chances of recovery. Some of the most deplorable 
cases of drug-habit are the combined morphine and cocaine habi- 
tues. 

A number of catarrh remedies are on the market at the present 
time. These consist of mixtures of cocaine and indifferent sub- 
stances, and are largely responsible for the spread of this pernicious 
habit. The negro roustabouts of the South are very prone to the 
habit, and the catarrh cures are in constant use among the prosti- 
tute class. 

Treatment of Acute Poisoning. — Several antidotes have been 
favorably adopted — amyl nitrite, caffeine, atropine, and inhalations 
of ammonia. Chloroform, ether, subcutaneously injected, and 
strychnine have also proved more or less efficient remedies. 

With regard to the withdrawal of cocaine, equally competent 
authorities appear to differ, the immediate cessation of the drug 
being advocated, and, again, this course condemned as liable to 
produce collapse. The general experience of those treating this 
class of patients is that a partial cure of the cocaine habit is com- 
paratively easy under careful" sanitarium supervision. General tonic 
treatment is imperative. 

Doses of from 35-15 grains have caused death in from eight to 
nine hours. 

Therapeutics. — Externally and Locally. — The indications for the 
local anesthetic action of cocaine are very numerous. The general 
surgeon will find many opportunities to employ the drug advan- 
tageously ; indeed, in many instances it has replaced all other anes- 



2i6 A TEXT-BOOK OF MATERIA MEDICA. 

thetics. In many operations on the genito-urinary tract, rectum, 
nose, throat, ear, and eye it serves a most valuable purpose. The 
urethra can be rendered perfectly insensible to pain by the applica- 
tion of a 2 to 4 per cent, solution, repeated two or three times at 
intervals of five or ten minutes. Even the sensibility of the bladder 
itself can be benumbed to a great extent by the local application 
of a cocaine solution, so that sounding for stone and its removal 
may be painlessly accomplished. 

Urethral caruncles may be removed successfully and without in- 
convenience to the patient by the injection of a 4 per cent, solution 
at the lines of attachment. An injection of a small amount of the 
same solution into the cellular tissue of the prepuce prevents pain 
in circumcision and in the operation for phimosis. In the treatment 
of fistula in a?w, hemorrhoids, both internal and external, and other 
diseases of the rectum, cocaine is of signal value. 

Cocaine is an important anesthetic in many minor operations, 
such as opening of felons, abscesses, etc ; it is also highly serviceable 
in dentistry and for the removal of small neoplasms. Probably its 
most extensive use in this respect is in operations upon the eye, 
nose, and throat, its widest field of usefulness being in operative 
ophthalmic surgery. 

Small doses of cocaine in combination with antipyrine and adre- 
nalin are very useful in acute coryza. Great care must be taken 
lest its use in this regard lead to the habit. 

The peculiar qualities of cocaine render it one of the safest, as 
well as most convenient and serviceable, mydriatics. It quickly 
dilates the pupil, which regains its normal condition in from ten to 
twenty hours. The dilatation, too, is easily overcome by the appli- 
cation of eserine, a solution of \ grain (0.03 Gm.) to 1 ounce (30.0 
Cc.) of the latter drug being strong enough to neutralize the effects 
of a 4 per cent, solution of cocaine. 

It should be remembered that local applications to the conjunc- 
tivae, nares, and fauces may produce in susceptible persons systemic 
effects. 

Cocaine combined with atropine forms a mydriatic which for 
many purposes is superior to either drug separately, the mydriasis 
being of longer duration than that produced by cocaine, while the 
paralysis of the accommodative apparatus is briefer than that occa- 
sioned by atropine. It should be remembered that iso-tropyl cocaine 
may cause great cardiac depression. 

The phenate of cocaine is less toxic than the hydrochlorate, 
owing to its power of coagulating albumin, and thereby being less 
readily absorbed. It is also more agreeable to the taste. While it 
does not produce anesthesia so readily as the hydrochlorate, its 
effect is more permanent, and, in addition, it possesses powerful 
antiseptic properties. By many physicians it is preferred in laryn- 
gological work. 

Internally. — Coca has been successfully used in gastralgia and 



HYPNOTICS. 217 

to improve the digestion. Cocaine is frequently an efficient remedy 
in sea-sickness and to allay excessive vomiting. 

Bartholow has highly recommended the drug in chorea, asthma, 
paralysis agitans, and alcoholic, and senile tremor. It has also been 
suggested as a cure for the opium, alcohol and tobacco habits. 

Spinal Analgesia. — Within recent years the use of cocaine, 
thrown into the spinal cord, has been very widespread. It was 
first pointed out by Corning, of New York, a number of years ago, 
that the injection of cocaine into the spinal nerve-roots would in- 
duce analgesia of the lower limbs, but little practical use was made 
of this suggestion. Bier, of Kiel, rehabilitated the procedure, 
adopting the newer points of technic brought out by Quincke in 
his observations on lumbar puncture, and performed major opera- 
tions below the umbilicus during the analgesia conferred by the 
drug. Tuffier, Murphy, Fowler, Bainbridge, Reclus, and many 
others have supplemented the early observations, and at the pres- 
ent time there is a large literature concerning the intrarachidian 
injections of cocaine in surgery. Many operations, heretofore im- 
possible to perform by reason of accompanying cardiac or renal 
disease, thus making the employment of ether or chloroform 
unwise, have been done successfully under cocaine analgesia. In 
many respects an ideal has been reached, but there are a number 
of drawbacks to its use here. Headache, nausea, vomiting, great ' 
prostration, and weakness, accompanied by dizziness, have been 
noted with varying constancy as following the use of the drug in 
this manner. Its use, therefore, presents some questions of expe- 
diency that subsequent experience must answer. 

A logical outcome of the use of cocaine in this manner in 
surgery is its use in persistent neuralgias — sciatic and others. 
These have been relieved in many instances, most often to return, 
yet at times not. The pains of tabes have also been markedly 
relieved by the same procedure. 

Time and experience alone will determine what the subsequent 
developments may be along these lines. 

Similar Products. — In coca leaves there are other cocaines, 
and still others are made synthetically from the ecgonine base, but 
these have not been used to any great extent. Cocainine, benzoyl- 
ecgonine, tropacocaine have been used sparingly. The last has 
been employed in spinal analgesia in the place of cocaine. 

Eucaine. — Alpha and beta-eucaine are newer artificial alkaloids 
used as substitutes for cocaine. They differ from cocaine in that 
they may be subjected to boiling and are not thereby decom- 
posed. Moreover, they are less toxic and have about equal 
analgesic properties. Beta-eucaine is to be preferred, as it is 
less irritating. On the eye, they do not dilate the pupils so widely 
and are capable of extensive employment in ophthalmic practice. 

Holocaine is a synthetic derivative from phenacetine, used 
widely in ophthalmic practice for much the same purposes. It is 
not so satisfactory in many respects. 



2i8 A TEXT-BOOK OF MATERIA MEDIC A. 

Orthoform— C 6 H 3 OH(NH 2 )(COOCH 3 )— meta-amidopara-oxy- 
benzoic-acid methyl ester, is another product of radically dif- 
ferent chemical composition, being derived from benzoic acid. It 
possesses many of the analgesic properties of cocaine. It is a 
white, slightly soluble powder, and is useful as a dusting-powder, 
proving antiseptic and analgesic at the same time. It is extensively 
used in the treatment of ulcers— rectal, urethral, laryngeal, gastric, 
etc. — of tuberculous, syphilitic, or carcinomatous origin, and offers 
excellent opportunities as a local analgesic, as it remains in contact 
for a considerable space of time because of its comparative insol- 
ubility. 

AnjEsthesix — C 6 H 4 / qqq^ it — ethyl para-amido-benzoate, is 

a similar body of like properties with the same general indications. 

Stovaine is a recent (1903) addition to this group. 

The following salts of cocaine have been manufactured and 
are used for much the same purposes as the hydrochloride and 
in the same dosage : Cocaine aluminium citrate, sulphate, borate, 
cantharidate, lactate, nitrate, phenate 4 saccharate, salicylate, and 
stearate. Cocapyrine is a mixture of cocaine and antipyrine, 1 : 100. 

Contraindications. — No special or distinct contraindication to 
its use exists. In diseases of the kidneys with diminished urinary 
flow it should be cautiously administered, lest total anuria ensues. 
With subjects suffering from weak or diseased heart, caution is to 
be used, as collapse has been frequently noted. 

Administration. — For hypodermic use, solutions of from 2 to 
5 per cent, are generally employed. 

It should be noted that children and females require smaller 
doses of the drug. 

It is altogether possible that many of the coca wines on the 
market contain varying quantities of cocaine. The reckless and 
indiscriminate prescription of these preparations, therefore, is liable 
to induce the cocaine habit. It is questionable, indeed, whether 
the administration of cocaine with a view to curing the intemperate 
use of opium, alcohol, or tobacco is wise. It frequently happens 
that patients thus treated lose their craving for the latter drugs 
only to acquire an inordinate appetite for cocaine, which, as has 
been shown, is possibly as dangerous as either of them, in its 
physical and moral effects. 

MOTOR DEPRESSANTS. 

A group of drugs of great pharmacological interest but at the 
present time of comparatively little therapeutic significance may be 
taken up in this place as contrasting most sharply with the group 
just considered. 

These are best represented by Curare and Conium. They are 
pure motor depressants; the preceding group representing pure 
sensory depressants. 



MOTOR DEPRESSANTS. 219 

The more classic of these motor depressants is curare, but conium, 
because of its more extended use in therapy, will be first considered. 
Gelsemium, a third member of the group, may be said in a general 
way to pertain to both the atropine-cocaine and the curare groups, 
as it shows characteristic reactions of both. 

A large number of drugs may be spoken of as motor depress- 
ants — thus, potassium bromide, in which the potassium ion is a 
muscle poison, the entire alcohol group reduce motor power, and 
many others, prussic acid, nicotine, aconite, etc., but it is preferred 
to group here only those in which the dominant action is that of 
depression of the functions of the muscle-plates. 



Conium— Conii— Conium. XT. &. 2*. 

(Spotted Hemlock.) 

Origin. — The full-grown but unripe fruit of Conium maculatum L., carefully 
dried and preserved, and yielding when assayed not less than 0.5 per cent, of coniine. 
After being kept for more than two years conium is unfit for use. Spotted hemlock is 
a biennial indigenous herb, a few feet high, growing in the temperate regions of Asia, 
Europe, and Northern Africa, and naturalized in some portions of New England, New 
York, and South America. It grows in waste places and along streams. 

Description and Properties. — About y% inch (3 Mm.) long, broadly ovate, 
laterally compressed, grayish-green, often divided into two mericarps, each with five 
crenate ribs, without oil-tubes, and containing a seed grooved on the face ; odor and 
taste slight. 

When triturated with solution of potassium or sodium hydrate conium gives off a 
strong, disagreeable, mouse-like odor. 

The most important constituent is a volatile liquid alkaloid, coniine. It also contains 
methyl-coniine, conhydrine, and its isomer pseudo-conine. The volatility of the alka- 
loid is largely responsible for the varying composition of the preparations and the 
discordant therapeutic results. 

Dose. — 1-5 grains (0.06-0.3 Gm. [3 grains (2 Gm.), U. S. P.]. 

Official Preparation. 

Fluidextractum Conii — Fluidextracti Conii— Fluidextract of Conium. — Dose, 
1-5 minims (0.06-0.3 Cc -) [3 minims (2 Cc), U. S. P.]. 

Coniine is closely related to piperidine ; its structural formula 
is that of propyl piperidine. (Compare Nicotine.) 




H-Cx H /C— H 



H— C— H H— C— (C 3 H 7 ) 



Propyl. 



Antagonists and Incompatibles. — Nux vomica and its alka- 
loids, cocculus and picrotoxin,are antagonistic to conium. Tannic 
acid and the alkalies are chemically incomparable. 

Synergists. — The motor depressants and morphine. 



220 A TEXT-BOOK OF MA TERIA MEDICA. 

Physiological Action. — Externally and Locally. — Coniine, the 
active principle of conium, has no effect upon the unbroken skin. 

Internally. — Digestive System. — Conium increases the salivary 
secretion, and when taken into the stomach exerts no special action 
upon the digestive system, other than an occasional disturbance of 
the gastro-intestinal tract, possibly resulting in vomiting and diar- 
rhea under full dosage. 

Nervous System. — The action of coniine in the higher cerebral 
centers is very slight. In some patients a mild drowsiness has been 
observed, but, as a rule, consciousness and the thought processes 
are not modified, save in the final stages of asphyxiation. The action 
on the medulla is also slight. 

Respiratory System. — Large or poisonous doses may depress the 
respiratory center, but paralysis of the muscles of respiration is 
probably responsible for death rather than poisoning of the centers. 

Spinal Cord and Motor Ganglia. — The action on the cord is not 
determined. Slight twitchings and even convulsions are sometimes 
observed, but it is not positive that central irritation is the cause. 

The characteristic action of conium is on the terminal end-plates 
in the voluntary muscles. These are paralyzed after a possible transi- 
tory stimulation. Some depression of motor-plates in involuntary 
muscles is also noted, particularly in the heart, but it is not as pro- 
nounced as in the plates of the voluntary muscles. 

Circulatory System. — Although when ingested coniine is rapidly 
absorbed by the blood, circulating in the system unchanged, its 
action is not clearly defined, though it has been held that the circu- 
lation is first accelerated and then retarded, with a lowering of arte- 
rial pressure preceded by a decided increase. 

From its capacity to paralyze the vagi terminals it is natural to 
suppose that it increases the rapidity of the cardiac movements, yet 
a characteristic feature of the absorption of coniine is the apparent 
absence of cardiac derangement, the heart, as well as the mind, re- 
maining unaffected in the presence of alarming symptons. 

Absorption and Elimination. — The drug is readily absorbed. Elim- 
ination is rapid and takes place chiefly through the kidneys and 
lungs. Coniine has been detected in considerable quantities in the 
liver, lungs, and spleen. 

Temperature. — It has been held that bodily temperature is per- 
ceptibly lowered by conium, proportionately with the extent of the 
paralysis occasioned. High authorities, however, assert an increase 
of temperature under both therapeutic and toxic doses. 

Eye. — Heaviness of the eyelids, dilated pupils, accompanied by 
double or confused vision and occasionally entire loss of sight, have 
been noted among the symptoms incident to the administration of 
active dosage. The paralysis of the third nerve is probably respon- 
sible. 

Poisoning. — A frequent symptom of conium-poisoning is ptosis, 
arising from paralysis of the oculomotor nerves. Staggering gait, 
general muscular relaxation, impairment of vision, nausea, and ver- 



MOTOR DEPRESSANTS. 221 

tigo are also not infrequent. The severer symptoms are marked by 
muscular paralysis of the extremities, derangement of vocal organs 
resulting in difficulty of speech, and dilatation of the pupils. The 
brain meanwhile remains unaffected until overcome by the accumu- 
lation of carbon dioxide gas in the blood, when delirium and coma 
may ensue, and finally cerebral convulsions and fatal collapse 
through respiratoryfailure. Doses of 2 gr. (0.15 gm.) conium have 
caused death within a half hour. Socrates is said to have died in 
40 minutes after taking the poisoned cup. 

Treatment of Poisoning. — The stomach should be evacuated by 
means of emetics or lavage, after which tannic acid and the phys- 
iological antidotes may be administered. Artificial respiration is 
practically the only expedient, as the paralyzed end-organs cannot 
physiologically respond to any drug irritation. 

Therapeutics. — Externally and Locally. — Conium leaves applied 
as a poultice relieve pain somewhat, as in ulcers and carcinoma, 
but other and better local analgesics are at hand, and its use in this 
respect is limited. 

It is very problematic whether conium has any well-marked 
therapeutic applications. If it is employed, it is absolutely essen- 
tial that a very fresh specimen be used, since the active alka- 
loid is volatile. It is perhaps best to use a salt of the alkaloid or a 
salt of methyl-coniine. On theoretical, as well as practical, grounds 
it can have little value in the involuntary spasmodic affections ; it 
can only mask muscular movement, not modify the pathological 
impulses. In voluntary habit spasms, however, it has its only 
practical uses. Here it may prevent the accomplishment of a 
morbid muscle impulse, and thus with suggestive therapeutics be 
of service in the treatment of the habit " tics," habit spasms, etc., 
particularly in their early stages. When the brain path is firmly 
established conium is of little service. 

Contraindications. — Conium should not be given to persons 
suffering from great exhaustion and debility or from diseases inter- 
fering with the rhythm of the heart. 

Administration. — The preparations of conium are very unreli- 
able, the assayed, or " standardized " fluid extract being perhaps the 
one to be depended upon most uniformly. Owing to the uncer- 
tainty of their strength, the administration should begin with small 
doses gradually augmented until interference with involuntary 
motion is observed, when further increase should be stopped. 

The effects of the drug are weakened by repeated doses, 
rendering an increase in the dose necessary from time to time. 
Coniine and morphine greatly aid each other, and this combination 
is a particularly efficient one in the treatment of painful muscular 
spasms and acute mania with excessive motor activity. Conium 
and sulphonal are of great value in insomnia accompanied by motor 
restlessness. 



222 A TEXT-BOOK OF MATERIA MEDICA. 

Curare— Curare— Curare (non-official). 

(WOORARI. ) 

Origin. — An extract of uncertain composition prepared by the natives of South 
America as an arrow-poison. Dr. Jobert reported to the French Academy in 1878 that 
the poison was prepared chiefly from Strychnos Castelnccana and other species of 
Strychnos, and Cocculus toxiferus, containing also variable quantities of other poison- 
ous plants, such as Didelphys cancrivora, etc. It is altogether probable that its in- 
gredients include the poison of venomous reptiles. Each tribe, however, has its own 
method for preparing curare, and the precise formulas are clan secrets. Bohm's studies 
in ibbj were among the first to give accurate details of the varieties, but these change 
from time to time. 

Description and Properties. — The extract is a blackish-brown, friable solid, 
brittle or hygroscopic, of a very bitter taste ; almost completely soluble in dilute alco- 
hol. Cold water dissolves about 75 per cent., which portion contains the poisonous 
alkaloids and is insoluble in ether and but sparingly soluble in absolute alcohol. 

The active constituents vary somewhat. Curarine is the name given by Bohm to 
the alkaloid, or impure nitrogenous base, which produces the typical paralyzing effects 
of curare. Other alkaloids have been named citrin and protocurarine, the former 
inert, the latter supposed to be very active. Bohm's studies have not been subjected to 
careful revision. 

Dose. — 2tf - l g ram (0.003-0.03 Gm. ), hypodermically given. 

Dose Of Curarine. — 2<Jo - T<hr g rain (0.0003-0.0006 Gm.), hypodermically. 

Antagonists and Incompatibles. — The excito-motors are an- 
tagonistic. Tannic acid and the caustic alkalies are chemically 
incompatible. 

Synergists. — The depresso-motors. 

Physiological Action. — When applied to the denuded skin it is 
an irritant. 

Nervous System. — No cerebral action is caused by moderate 
doses. The action on the medulla is slight in moderate dosage. 

Respiratory System. — Curare is a powerful respiratory depress- 
ant, paralyzing the ends of the motor nerves distributed to the 
respiratory muscles. When lethal doses have been given the 
paralysis may become central. Death results from asphyxia. 

Curare is absorbed very slowly from the stomach and is prob- 
ably little acted on in the body, as in animals most of it has been 
recovered from the urine. 

Spinal Cord and Peripheral Nerves. — The typical action of cur- 
are is on the end-plates of the motor nerves of striated muscles. 
These are paralyzed, the smaller muscles being first involved, hence 
ptosis, etc. The respiratory muscles are first acted on. Unstriped 
muscle terminations are not affected. Sensory nerves are unaffected. 
The peripheral ganglia of the sympathetic are paralyzed. The 
dilated pupil, the increased peristalsis, and involuntary evacuations 
are indications of this sympathetic nerve depression. 

Circulatory System. — Medicinal doses render the pulse fuller 
and rapid from vagus depression ; there is marked dilatation of the 
blood-vessels of the skin and the various glands ; while the blood- 
pressure, though little affected by small doses, is decidedly lowered 
by large ones. The ganglionic paresis causes the fall in pressure. 

Absorption and Elimination. — When ingested the process of 



MOTOR DEPRESSANTS. 223 

absorption is exceedingly slow, but when injected into the circula- 
tion the drug is rapidly absorbed. 

It is quickly eliminated by the kidneys, causing sugar to appear 
in the urine. A portion of the poison is also excreted with the 
feces. The sweat, saliva, nasal mucus, and tears, although their 
secretion is greatly increased by the drug, do not seem to share in 
the process of elimination. Metabolism in general is checked. 

Poisoning. — Curare is a rapid and active poison. The move- 
ments of the heart are greatly accelerated ; the pulse is weak and 
dicrotic ; the temperature is elevated, and the respiration corre- 
spondingly depressed ; extreme muscular weakness ensues, with 
incoordination of movements ; the urine becomes saccharine. 
Finally, paralysis of the extremities and the respiratory muscles 
supervenes, death occurring from respiratory paralysis. 

Treatment of Poisoning. — The same as in the treatment of poi- 
soning from conium, with catheterization of the bladder to favor 
elimination, and artificial respiration. 

Therapeutics. — While of great scientific interest and of value 
for experimental purposes in ascertaining the effect of certain drugs 
upon animals, the therapeutic uses of curare are very limited. It 
is indicated only in those diseases for which conium has proved of 
some service. 

Contraindications. — The same as for conium. 

Administration. — The crude drug or the alkaloid curare should 
be given hypodermically. 

Gelsemium— Gelsemii— Gelsemium. U. S. JP. 

(Yellow Jasmine.) 

Origin. — The dried rhizome and roots of Gelsemium sempervirens (L.) Pers., a 
plant indigenous in the southern United States, growing in moist woods. 

Description and Properties. — Cylindrical, long or cut in sections about 1 
inch (25 Mm.) in length, externally light-yellowish brown, with purplish-brown longi- 
tudinal lines ; tough, fracture splintery ; bark thin, with silky bast-fibers closely 
adhering to the pale-yellowish, porous wood, which has five medullary rays, and in 
the rhizome a thin pith ; odor aromatic, heavy ; taste bitter. 

It contains two alkaloids, gelsemine, with an action on frogs resembling strychnine, 
and gelseminine, which acts more like coniine. The general effects are therefore 
blended, but gelseminine is the more potent alkaloid, for man at least. 

Dose. — 2-10 grains (0.13-0.6 Gm.) [1 grain (0.065 Gm.), U. S. P.]. 

Official Preparations. 

Fluidextractum Gelsemii — Fluidextracti Gelsemii— Fluid Extract of Gel- 
semium. — Dose, 2-10 minims (0.12-0.6 Cc.) [1 minim (0.05 Cc), U. S. P.]. 

Tinctura Gelsemii — Tincturae Gelsemii— Tincture of Gelsemium.— Dose, 
15-60 minims (1.0-4.0 Cc.) [8 minins (0.5 Cc), U. S. P.]. 

Gelsemina (unofficial) — Gelseminse — Gelsemine. — Description and Proper- 
ties. — A brittle solid, transparent, crystallizable mass, converted into a colorless liquid 
at 45 C. (ii3°F.). Insoluble in cold water, but soluble to a slight extent in hot 
water, as well as in alcohol ; taste bitter. 

Dose. — ^i^-jL. grain (0.0003-0.001 Gm. ). 

The action of gelsemium throughout resembles that of conium 



224 A TEXT-BOOK OF MATERIA MEDICA. 

and curare very closely. There are certain points of difference, 
however, that render this drug much more valuable therapeutically 
than either of the others. 

On the cerebrum, gelsemium shows a more pronounced depress- 
ing action, causing drowsiness and depression. As this is often a 
late symptom with large doses it may be due to beginning asphyx- 
iation. 

Gelsemium depresses the respiratory center more than does 
curare. It also has a classical peripheral action. 

Gelsemium has a distinct action on sensory nerves. It is, there- 
fore, useful in painful affections. 

The heart action under medicinal doses of gelsemium is more 
apt to be slowed than quickened, as with the more powerful curare. 
This would seem to indicate less depression of the vagus. It has 
a pronounced effect on the sympathetic ganglia and is useful thera- 
peutically in reducing blood-pressure. 

Poiso7iing. — In toxic doses gelsemium is quickly fatal. The 
early symptoms include drooping of the eyelids, wide dilatation and 
immobility of the pupils, extreme muscular weakness, affecting first 
the muscles of the upper extremities, and incoordination of move- 
ments. Diplopia and dimness of vision may ensue, accompanied 
by difficulty of speech, coldness of the body surface, and general 
cutaneous anesthesia, with decidedly lower temperature. Mean- 
while, there is marked diminution in the force of the heart and 
respiratory paralysis. Death has resulted from a teaspoonful of the 
fluid extract, -jt gr. of gelseminine is given as a minimum lethal 
dose. 

While the patient may be drowsy, the mind is unaffected until 
carbonic-acid narcosis supervenes. Death is usually the result of 
respiratory failure, due to paralysis of the muscles of respiration. 
Paralysis of the heart also occurs. 

Treatment of Poisoning. — The evacuation of the stomach is of 
the first importance, either by the stomach-pump or by the use of 
emetics. Washing out with a solution of tannic acid is probably 
the best method to pursue. External heat should be applied and 
diffusible stimulants administered, followed by digitalis and strych- 
nine. The hypodermic injection of morphine and atropine is highly 
recommended in gelsemium-poisoning. Artificial respiration is 
imperative. 

Therapeutics. — Externally and Locally, — The drug is seldom 
used external!}', although it has been employed by ophthalmolo- 
gists as a mydriatic. 

Internally. — Clinically, gelsemium is now considered less valu- 
able than formerly. It has been favorably mentioned by certain 
authors in the treatment of tetanus, mania with motor excitement, 
and paralysis agitans. 

The drug appears to be more serviceable in trifacial neuralgia, 
and it seems to be even more efficient in neuralgia with involve- 
ment of the inferior dental nerve. In these disorders, as in ovarian 



MOTOR DEPRESSANTS. 225 

neuralgia, dysmenorrhea, etc., for which it has been employed with 
some success, the drug should be pushed to its physiological limit. 

Bartholow praised the action of gelsemium in cerebrospinal 
meningitis and " acute inflammations of the kings and pleura!' 

Bulkley is responsible for its use in pruritus and eczema, the 
itching of which it certainly appears to alleviate. 

Contraindications. — Diseases accompanied by exhaustion and 
great muscular weakness. 

Administration. — Any of the preparations may be given, the 
initial dose being small, and the amount increased gradually until 
dilatation of the pupil or drooping of the eyelids is manifest. 



Scoparius— Scoparii— Scoparius. U. S. P. 

(Broom.) 

Origin. — The dried tops of Cytisus scoparius L., a shrub 3 to 6 feet (0.9-1.8 M.) 
high, found in Western Siberia and the greater part of Europe. It is sometimes culti- 
vated, and is occasionally met with wild in some of the Middle and Southern States. 

Description and Properties. — Occurring in ihin, flexible, branched twigs, 
pentangular, winged, dark green, nearly smooth, tough, usually free from leaves ; odor 
peculiar when bruised ; taste disagreeably bitter. 

The constituents of scoparius are sparteine, a pyridine alkaloid, similar in composi- 
tion to coniine, and a neutral, crystalline principle, scoparin, to which the diuretic 
action of the drug is thought to be due. 

Dose. — g— I dram (2.0-4.0 Cc.) in infusion [15 grains (1 Gm.), U. S. P.]. 

Official Preparation. 

Sparteinae Sulphas — Sparteinae Sulphatis — Sparteine Sulphate. — The sul- 
phate of an alkaloid obtained from scoparius. 

Description and Properties. — Colorless, white, prismatic crystals, or a granular 
powder, odorless, and having a slightly saline and somewhat bitter taste; liable to 
attract moisture when exposed to damp air ; very soluble in water and alcohol. — Dose, 
■io~ 2 grains (0.003-0. 1 Gm.) [A grain (0.01 Gm.), U. S. P.]. 

Physiological Action. — Externally and Locally. — No action 
observed. 

Internally. — Digestive System. — Sparteine sulphate acts like bit- 
ters in improving the appetite and digestion. Large doses, as with 
digitalis, producing vomiting and purging. 

Nervous System. — Sparteine resembles coniine in its action upon 
the nervous system, depressing the brain and spinal cord, and 
lowering reflex action through paralysis of the motor nerve-end- 
ings. Under toxic doses there is also extreme muscular weakness, 
often complete paralysis. 

Circulatory System. — Cushny and Matthews claim that the 
action of sparteine upon the heart and blood-vessels is similar to 
that of digitalis, and numerous experiments upon animals show 
that while the drug has a slowing action on the heart it is not of 
the type induced by the action of digitalis — i. e., muscle irritation 
and vagus stimulation. 

Respiratory System. — Medicinal doses produce no effect. Toxic 

15 



226 A TEXT-BOOK OF MATERIA MEDICA. 

doses slow and weaken the respiration, death being possible from 
paralysis of muscles of respiration and asphyxia. 

Absorption and Elimination. — It is rapidly absorbed and as read- 
ily eliminated, and, unlike digitalis, has no cumulative action. In 
disease it is an active diuretic, particularly the infusion or fluid- 
extract or the alkaloid scoparin. Sparteine, on the other hand, is 
not an active diuretic. 

Scoparius therefore increases the flow of urine and the excretion 
of urea. The drug has a direct action upon the renal structure. 

Poisoning. — The following symptoms occur : Small, rapid, and 
irregular pulse, dyspnea, great muscular weakness, incoordination 
of movement, and muscular tremors, followed possibly by clonic 
and tonic convulsions, which are replaced by marked depression of 
the nervous and muscular system, and collapse. 

Treatment of Poisoning. — Respiration should be maintained by 
artificial respiration. Potassium iodide or solutions of tannic acid 
should be given, and the free use of diuretics or diluents to favor 
elimination. 

Therapeutics. — Externally and Locally. — No influence is ex- 
erted. 

Internally. — Scoparius was formerly used for the same purposes 
as digitalis, but it is highly improbable that it is of great value. It 
is serviceable in some cases of nephritis with weak, irregular heart- 
action, and in chronic Bright 's disease with cardiac hypertrophy and 
high arterial tension. It is also useful in the nervous, irregular 
heart of opium habitues. Its main value is as a diuretic. 

Contraindications. — Practically the same as forconium, though 
less definite. 

Administration. — The fluidextract of scoparius may be given 
or the decoction, made by adding | an ounce (16.0 Gm.) of the 
broom-tops to 1 pint (J liter) of water and boiling them down to 
J pint (250 Cc). Of this 1 ounce (32.0 Cc.) should be taken every 
three hours. This decoction is one of the most efficient diuretics 
in cardiac dropsy. 

The sparteine sulphate is usually employed when an action on 
the heart is desired ; it may be administered either hypodermically 
or in pill, capsule, or aqueous solution. 

MOTOR EXCITANTS, 

STRYCHNINE GROUP. 

Viewed from a general point of view there are a large number 
of drugs that might readily be classed as motor excitants. Thus 
both belladonna and coca cause increased motor excitability and 
might be here included. This illustrates the futility in the present 
state of pharmacological knowledge of employing such widely de- 
scriptive terms. 

The strychnine group of motor excitants contains a number of 



MOTOR EXCITANTS. 227 

drugs that act largely on the spinal cord, increasing the activity 
of its reflex functions. The more important of these are nux vomica, 
containing strychnine and brucine ; thebaine in opium ; gelsemium, 
the gelsemine of which acts as strychnine ; the gelseminine, as has 
already been seen, behaving like coniine ; spigeha also contains a 
tetanizing alkaloid ; physostigma contains calabarine of similar 
action. 

Bacillus tetani contributes a tetano-toxin, with a typical strych- 
nine-like action. 

Nux vomica itself has been widely used in medicine. Our modern 
knowledge dates back to 1540, when it was exported from the East 
Indies. Many of the natives of Java and of South America have 
used various species of strychnos in the preparation of arrow poisons. 

The most typical member of the group is nux vomica. 

Nux Vomica— Nucis Vomicae— Nux Vomica. 

u. s. r. 

Origin. — The dried, ripe seed of Strychnos Nux-vomica L. Yielding when 
assayed not less than 1.25 per cent, of strychnine. 

Nux vomica is a small tree common in many parts of Hindustan, Farther India, 
some of the East Indies, and in some parts of Australia. 

Description and Properties. — Nux vomica is about 1 inch (25 Mm.) in 
diameter, orbicular, grayish or greenish-gray ; soft-hairy, of a silky luster, with a slight 
ridge extending from the center of one side to the edge ; internally horny, somewhat 
translucent, very tough, with a large circular cavity, into which the heart-shaped, 
nerved cotyledons project. It is inodorous and persistently bitter. 

Nux vomica contains two important alkaloids — strychnine and brucine, the former 
being in excess. The seeds also contain igasuric acid, with which these alkaloids are 
combined. Of total alkaloids the drug should contain from 2.5 to 5 per cent. Strych- 
nine is a quinoline derivative, brucine being closely related. The former is found in 
from y 2 to 2 per cent, in the seed, the latter in smaller proportions, but in Strychnos 
ignatia brucine is found in comparatively large quantities. Strychnine was isolated by 
Pelletier in 1818, brucine in the following year, and notwithstanding constant research 
their exact composition is not definitely known. Suffice it for the present to class them 
with the chinolin alkaloids. 

Dose. — 1-5 grains (0.06-0.3 Gm.) [1 grain (0.065 Gm.), U. S. P.]. 

Official Preparations. 

Extractum Nucis Vomicae — Extracti Nucis Vomicae — Extract of Nux 
Vomica. — Dose, %-% grain (0.008-0003 Gm.) [^ grain (0.015 Gm.), U. S. P.]. 

Fluidextractum Nucis Vomicae— Fluidextracti Nucis Vomicae — Fluidex- 
tract of Nux Vomica.— Dose, 1-5 minims (0.06-0.3 Cc) \i minim (0.05 Gm.), 
U. S. P.]. v 

Tinctura Nucis Vomicae— Tincturae Nucis Vomicae — Tincture of Nux 
Vomica (o. I Gm. strychnine in 100 Cc). — Dose, 5-20 minims (0.3-I.2 Cc.) Tio 
minims (0.6 Cc), U. S. P.]. 

Strychnina— Strychninae— Strychnine. U. 8. JP. 

Origin. — An alkaloid obtained from nux vomica, and also derived from other 
plants of the Loganiacece. 

Description and Properties. — Colorless, transparent, octahedral or pris- 
matic crystals, or a white, crystalline powder, odorless, and having an intensely bitter 
taste, perceptible even in highly dilute (1 : 700,000) solution. Permanent in the air. 
Soluble at 15 C. (59 F.) in 6400 parts of water, in 1 10 parts of alcohol, in 2500 
parts of boiling water, and in 12 parts of boiling alcohol ; also soluble in 7 parts of 
chloroform, but almost insoluble in ether. 

Dose. — 6?~T6 g rain (o.coi-0.004 Gm.) [^ ¥ grain (o.ooi Gm.), U. S. P.]. 



228 A TEXT-BOOK OF MATERIA MEDICA. 

Strychninae Nitras — Strychninae Nitratis — Strychnine Nitrate (U. S. P.). — 
Colorless, glistening needles, odorless, and having an intensely bitter taste ; permanent 
in the air. Soluble in water (i : 42), alcohol [1 : 120), and glycerin (1 : 60) ; much 
more soluble in warm water or alcohol. The nitrate contains no water of crystalliza- 
tion and is permanent in the air. — Dose, " Average dose : -gL grain (0.001 Gm. = I 
milligramme)," U. S. P. 

Strychninae Sulphas— Strychninae Sulphatis — Strychnine Sulphate (U.S. P.). 
— Description and Properties. — Colorless or white, prismatic crystals, odorless, and 
having an intensely bitter taste, perceptible even in highly dilute ( 1 : 700,000) solu- 
tion. Efflorescent in dry air. Soluble at 25 C. in 31 parts of water and in 65 parts 
of alcohol; also soluble in 2 parts of boiling water and 8.5 parts of boiling alcohol. 
Almost insoluble in ether. — Dose, ^-"iV g rai n (0.001-0.004 Gm.) [J ? grain (0.001 
Gm. ), U. S. P.]. 

Strychnine or its salts enter into a number of official preparations. 

Antagonists and Incompatibles. — Chloral, chloroform, ether, 
and other of the methane derivatives antagonize the toxic action 
of strychnine. 

The incompatibles are tannic acid, bromides, iodides, and chlo- 
rides. 

Synergists. — The motor excitants, ergot, ustiiago, electricity, 
and cold. 

Physiological Action. — Since strychnine fully represents the 
physiological action of nux vomica, that of the former is here 
given. 

Externally and Locally. — In large doses strychnine acts as an 
antiseptic, but on account of its poisonous nature it is too dangerous 
to be serviceable. When applied locally to unicellular organisms, 
in very dilute solutions, the drug acts as a stimulant, increasing 
their movements. In slightly more concentrated solutions strych- 
nine arrests these movements and destroys life. 

Internally. — Digestive System. — Strychnine is an excellent sto- 
machic tonic, improving the appetite greatly and aiding digestion. 
By its action as a bitter it reflexly stimulates the saliva and increases 
the secretion of gastric juice, and by imparting tone to the muscular 
walls of the intestines it increases peristalsis and allays constipation 
when due to lack of muscular tone. Strychnine is fully absorbed 
and exerts its chief activities in the spinal axis. 

Nervous System. — Strychnine increases markedly the excitability 
of the central nervous axis. On the cerebrum it acts as an excitant, 
particularly keying up the patient. The motor cortex is somewhat 
stimulated. The acuity of the special senses is heightened. It 
stimulates attention. Even its cerebral action may be interpreted, 
however, as due to an increase in the reflex excitability. Physiologi- 
cally it may be said that the motor and sensory neurons are 
more closely bound together, cither being more permeable to nerv- 
ous influences or their insulation becomes reduced. There is no 
direct impairment of consciousness as the result of large doses. 

Spinal Cord and Peripheral Nerves. — : The first symptom of the 
drug is an increase in the spinal reflexes. This Holton and Muir- 
head think is due to a diminished resistance between the cells in 
the anterior and posterior horns of the cord. Normally, stimula- 



MOTOR EXCITANTS. 229 

tion of a certain part — as, for instance, of a frog's toe — simply occa- 
sions a movement of the part stimulated, no other point being 
affected. But under the influence of strychnine the slightest stimu- 
lation is often sufficient to throw the whole body into tetanic con- 
traction, showing that not only is the resistance in the normal path 
followed by lessened reflexes, but that resistance in all directions is 
diminished to such an extent that the impulse affects the entire 
muscular system. This action on the reflexes is principally on the 
cord. In fact, the action of strychnine upon the cord seems to be 
more powerful than upon any other portion of the central nervous 
axis. Very large doses of strychnine cause paralysis of the motor 
apparatus, with loss of voluntary movement, due to overstimulation 
of the reflex centers in the cord, producing exhaustion. 

It must be remembered that strychnine does not increase the 
automatic powers, but simply augments their susceptibility to exter- 
nal stimulation ; the slightest external stimulus leading to a greatly 
exaggerated reflex ; he exact mechanism in man is not yet known. 
Analogies drawn from the reflexes in frogs are not reliable. The 
reflexes in the human spinal cord are so complex that a study of the 
action of strychnine on monkeys alone will probably unravel the 
actual feature in its activity. 

Respiratory System. — By the stimulating effect of strychnine upon 
the respiratory center in the medulla the breathing is rendered 
quicker and deeper. Owing to the tetanic contractions of the respi- 
ratory muscles, under poisonous doses the breathing is greatly 
interrupted, and the patient may become asphyxiated. At length, 
the respiratory muscles becoming completely exhausted, death 
ensues either from excessive tetanic contraction and asphyxiation 
or from central respiratory paralysis. It is to be noted that the 
heart continues to beat for some time after respiration has ceased. 

Circulatory System. — Strychnine stimulates the heart by its action 
on the cardiac muscle. Pharmacologically the pulse should be de- 
creased, owing to the stimulating action of the vagus center in the 
medulla. But this depressing influence seems to be overcome by 
the direct stimulating action upon the heart muscle. In therapeutic 
doses it is generally held that the pulse is slightly increased. In 
poisonous doses the pulse is slowed and weakened, owing to over- 
stimulation of both the heart-muscle and the motor mechanism. 
There is marked increase in the blood-pressure, with constriction 
of the vessels, particularly those of the viscera. 

Absorption and Elimination. — Strychnine is rapidly absorbed and 
slowly excreted. It is eliminated mainly by the kidneys, appearing 
in the urine as strychnine, and is also slightly excreted by the skin 
and the salivary glands. It has been detected in the urine as late as 
eight days after ingestion. 

Metabolism. — From its marked action in increasing muscular 
activity metabolism is greatly hastened. Carbon dioxide is increased 
and there is heightened oxidation. 

Temperature. — Under therapeutic doses the temperature is 



230 A TEXT-BOOK OF MATERIA MEDIC A. 

slightly raised, owing to increased oxidation, as shown by the 
increase of urea and carbon dioxide eliminated, and of oxygen 
taken in. During the tetanic convulsions the body temperature 
is markedly raised, though it is generally greatly reduced during 
the stage of exhaustion immediately preceding death. 

Eye. — The general nervous stimulation produced by strychnine 
affects the mechanism of the eye ; vision, as has been remarked, 
being rendered more acute. 

Poisoning. — As is the case with other active poisons, strychnine 
in lethal doses produces varying effects, dependent upon tempera- 
ment, idiosyncrasy, and physiological conditions. Generally speak- 
ing, the absorption of large doses is followed by rigidity of the 
lower maxillary, dilatation of the pupils, increased action of the 
reflexes, and spasmodic and distressing muscular contraction, affect- 
ing the extensors particularly. Finally, the respiratory muscles 
are affected with tetanic rigidity, death resulting from asphyxia. 
In many cases the earliest symptoms of poisoning are restlessness 
and anxiety, twitching of the muscles, and stiffness of the neck. 
Spinal convulsions are manifested, the patient assuming the position 
of opisthotonos, so that he rests upon his head and his heels. 

The slightest external irritation at this stage, even a movement 
of the bedclothes, is sufficient to cause a recurrence of convulsions. 
Notwithstanding these grave symptoms, the mind remains unaf- 
fected until carbonic-acid poisoning sets in, and the stomach is 
usually retentive. Accompanying the usual symptoms in cases 
of acute poisoning is the distortion of the features, which assume 
a ghastly grin (risus sardonicus). The action upon the genito- 
urinary tract is quite marked, involuntary ejaculations of semen 
frequently taking place, together with incontinence of urine. 

The earlier paroxysms attendant upon the effects of the drug 
are seldom fatal, but in the intervals of repose the patient's mind 
is oppressed with a sense of impending dissolution, intensified by 
each renewed access of spasm and increasing severity of pain. 

Symptoms from \ grain usually begin \ hour after taking. 
Patients have been known to die from fatal dose in 15 minutes. 
Two hours is more often — 6 to 8 hours also. Minimum lethal 
dose lies between J to \ grain (.030-010 Gm.). Birds are usually 
immune to strychnine. 

Treatment of Poisoning. — Emetics and cleansing of the stomach 
are naturally of the first importance. Animal charcoal and tannic 
acid should be freely administered, while copious anal injections 
containing potassium bromide and chloral are often efficacious in 
relieving the spasms. Chloroform may be needed. Artificial 
respiration is imperative, but must be continued for a long time, as 
the drug is so slowly eliminated. 

Therapeutics. — The chief local action of strychnine is that of 
a bitter. There is no more efficient remedy in atonic dyspep- 
sia than nux vomica or strychnine. Both possess all the prop- 
erties of the simple bitters, besides stimulating the nerve-centers, 



MOTOR EXCITANTS. 231 

rendering the coordination of the digestive process more perfect 
and enabling the stomach to respond more readily when the stim- 
ulus of food is applied to it. Small doses, 5 to 10 minims of the 
tincture frequently repeated — intermitting. 

The gastric catarrh of inebriates is especially benefited by this 
drug, which also serves a useful purpose in the vomiting of preg- 
nancy and of phthisis. 

Its tonic action upon the intestinal muscles renders it an invalu- 
able remedy in habitual constipation and atonic diarrhea. 

Strychnine is a most valuable cardiac tonic, having a marked 
action on the cardiac nervous system and also upon the heart- 
muscle. In pneumonia, typhoid fever, and other diseases accom- 
panied by dyspnea and feeble heart-action, it is certainly valuable 
in small doses, but it is by no means the sheet anchor it has been 
thought to be. It is particularly valuable, however, in failing blood- 
pressure. The hypodermic injection of full doses of strychnine 
ordinarily renders the pulse full and strong, even when it is scarcely 
perceptible, and death appears imminent. Many clinicians believe 
that they have tided pneumonic patients over the critical period by 
the heroic use of strychnine. The functional irregularity of .the 
heart's action accompanying hysteria, hypochondriasis, and preg- 
nancy is greatly relieved by moderate doses of tincture of nux 
vomica. 

As- a tonic in chlorosis and anemia strychnine is an esteemed 
remedy, particularly in combination with iron. 

In bronchial and neurotic asthma, as well as in many forms of 
neuralgia, particularly the visceral variety, the drug is an efficient 
remedy. In bronchitis also, and to relieve the coughs, of neurotic 
origin, it is of great value. 

Strychnine is particularly valuable in all of the affections of the 
spinal-peripheral motor neuron. Anterior poliomyelitis, and the 
various neuritides. Lead, alcohol, tobacco, diphtheria, typhoid, 
grippe, pressure neuritides are much benefited by large doses. 

Strychnine is exceedingly efficacious in amaurosis due to excess- 
ive use of alcohol or tobacco, being also valuable in paresis of the 
ocular muscles. Night-blindness is also greatly benefited by this 
drug. 

The weak and semiparalytic condition sometimes induced by 
bromides is improved by strychnine. 

Hammond has obtained excellent functional results in tabes 
from massive doses of strychnine. 

It is of undoubted merit in delirium tremens, as well as in pre- 
venting the usual effects of alcoholic intoxication ; in fact, the drug 
is one of the best remedies in the treatment of alcoholism, the 
strychnine nitrate being usually employed — hypodermically. Ac- 
cording to the best authorities on dipsomania, strychnine seems to 
be a true antagonist to the untoward action of alcohol, and it is 
probably the important constituent of the numerous " cures " for 
the alcohol habit. 



232 A TEXT-BOOK OF MATERIA MEDICA. 

No less valuable is strychnine in the treatment of acute poisoning 
by chloral, morphine ', and physostigmine. 

As an aphrodisiac it is of unquestioned value m fiinctional sper- 
matorrhea, and it is thought to produce contractions of the gravid 
uterus and cause abortio?i or premature delivery. When a predis- 
position to post-partnm liemorrliage exists, the administration of 
strychnine may prove of great service. 

Finally, strychnine has been highly recommended in the niglit- 
sii'eats of phthisis and in diabetes mellitus. 

Contraindications. — Strychnine is contraindicated in acute 
inflammatory conditions of the spinal cord and excessive reflex 
irritability. 

Administration. — The extract of nux vomica, the tincture, the 
fluidextract, or the alkaloid strychnine may be given and gradually 
increased. Better results are usually obtained if the drug is with- 
held for a time after its gradual use. The salts of strychnine are 
preferable to other preparations, the crude drug and its preparations 
varying greatly in strength, 10 minims (0.6 Cc.) of one tincture 
sometimes containing as large a percentage of strychnine as 20 
minims (1.2 Cc.) of another. 

The drug should be cautiously administered to children, the 
initial dose for a child five or six years of age not exceeding 
y^-q- grain (0.0006 Gm.). 

In using strychnine hypodermically the soluble hypodermic 
tablets should be freshly dissolved in distilled water. 

The solution of strychnine and of the other alkaloids should 
not be kept in stock, as they become contaminated with microscopic 
plants. 

Hydrastis— Hydrastis— Hydrastis. V. S. JP. 

(Golden Seal.) 

Origin.— The dried rhizome and roots of Hydrastis canadensis L., yielding, when 
assayed, not less than 2.5 per cent, of hydrastine. Closely related to strychnine in 
some particulars, and also having a marked action on unstriped muscle, raising blood- 
pressure, exerting an influence on the uterine muscle and on the walls of the stomach 
and bladder in the alkaloid hydrastine of hydrastis. Hydrastis is a perennial native 
to Canada and the United States east of the Mississippi, growing in rich woodlands 
and in the Southern States, confined to mountainous districts. 

Description and Properties.— The rhizome is from 1 to 2 inches (2-5 Cm.) 
long and about \ inch (6 Mm.) thick, oblique, with short branches, somewhat annu- 
late and longitudinally wrinkled; externally brownish-gray; fracture short, waxy, 
reddish-vellow, with a thickish bark, about ten narrow wood-wedges, broad medullary 
ray^. and large pith. Roots thin, brittle, with a thick yellow bark and subquadrangular 
woody center. Odor slight, taste bitter. 

The principal constituents are hydrastine (colorless and slightly acrid), berberine 
(yellow .Mid intensely bitter), and xanthopuccin or c ana dine. Berberine is also found 
beris, Colombo, menispennum, coptis, etc. Ilydrastinine, an artificial alkaloid 
prepared from hydrastine, has a very marked action on blood-pressure. 

Hydrastine is related chemically to narcotine, of the opium series. 

Dose. — 30 grains (2 Gm.), U. S. P. 



MOTOR EXCITANTS. 233 

Official Preparations. 

Fluidextractum Hydrastis — Fluidextracti Hydrastis — Fluidextract of 

Hydrastis. — Dose, 10-30 minims (0.2-2.0 Cc. ) [30 minims (2 Cc. ), U. S. P.]. 

Glyceritum Hydrastis — Glyceriti Hydrastis — Glycerite of Hydrastis. — 
Used externally. — Dose, 5 minims (0.3 Cc), U. S. P. 

Tinctura Hydrastis — Tincturae Hydrastis — Tincture of Hydrastis (20 per 
cent.). — Dose, 30-60 minims (2.0-4.0 Cc.) [1 dram (4 Cc), U. S. P.]. 

Hydrastina — Hydrastinae— Hydrastine.— An alkaloid obtained from hydrastis. 

Origin, Description, and Properties. — Colorless, very brilliant, glassy crystals; 
taste slightly acrid ; fully soluble in ether and chloroform, but freely soluble in water. 
— Dose, g-L-i grain (0.002-0.03 Gm.) [| grain (o.oi Gm.j, U. S. P.]. 

Hydrastinae Hydrochloridum — Hydrastininae Hydrochloridi — Hydrastinine 
Hydrochloride (U. S. P.). — Origin. — The hydrochloride of an artificial alkaloid 
derived from hydrastine. 

Description and Properties. — Light-yellow, amorphous granules, or a pale-yellow 
crystalline powder, odorless, and having a bitter, saline taste ; deliquescent on exposure 
to damp air. Soluble in 0.3 part of water and in 3 parts of alcohol. The product should 
be kept in well-stoppered vials. — Dose, T V-i grain (0.005-0.003 Gm. ) [| grain (0.3 
Gm.), U. S. P.]. 

Antagonists and Incompatibles. — The alkalies, mineral acids, 
and tannic and other vegetable acids are incompatible with prepara- 
tions of hydrastis. The physiological antagonists are the methane 
narcotics. 

Synergists. — Quinine and the vegetable bitters aid its action 
upon the digestive tract, ergot upon the uterus, and strychnine 
upon the spinal cord. 

Physiological Action. — Externally and Locally. — Hydrastine 
possesses little or no action when applied locally, and upon the 
eye its effect is to contract and afterward dilate the pupil. 

Internally. — Digestive System. — Its action is that of a bitter, 
stimulating the saliva and enteric secretions. In excessive doses it 
produces gastric disturbance, almost invariably occasioning vomiting. 

Nervous System. — The action of hydrastis on the nervous system 
is similar in many respects to that of strychnine, particularly on the 
medulla and spinal cord. Cerebral effects are not described with 
definiteness in man. 

Spinal Cord and Peripheral Nerves. — The cord is stimulated. 
The reflexes are increased with tonic, and at times clonic, convul- 
sions, and tetany of the respiratory musculature may occur. 

Respiratory System. — It stimulates the respiratory center. 

Circulatory System. — The vagus is stimulated, causing a prelimi- 
nary slowing of the heart. It may also have a distinct poisonous 
action on the heart-muscle. Arterial tension is raised. Large 
doses weaken the heart and drop pressure. 

Absorption and Elimination. — It is slowly absorbed, tending to 
accumulate in the system. It is eliminated chiefly by the kidneys, 
increasing slightly the urinary flow. 

Temperature. — Medicinal doses have no effect ; poisonous doses 
decrease bodily heat. 

Eye. — It has no particular action upon the eye, other than at 
first to contract and then to dilate the pupil when directly applied. 



234 A TEXT-BOOK OF MATERIA MEDICA. 

Uterus. — Hydrastine is a feeble oxytocic, affecting the womb in 
a manner similar to, though much less powerful than, ergot. 

Pembrey and Phillips claim that it has no action on the uterus. 

Poisoning. — The symptoms are almost identical with those of 
strychnine, and the same line of treatment is to be followed. Fatal 
poisoning is practically unknown. 

Therapeutics. — Externally and Locally. — The fluidextract of 
hydrastis, 15 to 20 minims (1. 0-1.2 Cc.) to 4 ounces (118 Cc.) of 
water, makes an efficient injection in gonorrhea. 

The topical action of hydrastis and its preparations is that of an 
antiseptic and tonic, strengthening the circulation and nutrition, 
rendering the drug peculiarly valuable in diseases of mucous sur- 
faces. 

The tincture — 1 fluidram (3.7 Cc.) to 1 ounce (30.0 Cc.) of 
water — is a valuable mouth-wash in all i? idol ent and offensive ulcera- 
tions of the month and throat, such as syphilitic and mercurial affec- 
tions, follicular pharyngitis, etc. 

The fluidextract serves a useful purpose in the local treat- 
ment of anal fissures and of rectal ulcer, vaginal and uterine ulcera- 
tions and leukorrhea. Indolent ulcers are stimulated by the bitter 
action to a healthier condition by the application of this preparation. 

Internally. — As a remedy for diseased conditions of the stomach 
and bowels it is of much the same value as the vegetable bitters 
and may be used for the same purpose. 

Hydrastine, and more particularly hydrastinine or its closely 
related body cotamine, acts upon the uterus very much like ergot, 
and has been highly recommended by well-known authorities in 
uterine hemorrhages and other uterine disorders for which ergot is 
used. By careful observers, of experience with the drug, it is con- 
sidered superior to ergot in the hemorrhage of puberty and the 
menopause as well as congestive dysmenorrhea. 

Koniger has treated hemoptysis successfully with the fluid- 
extract in 20- or 30-minim (1.2-2.0 Cc.) doses, repeated several 
times a day. The drug has proved equally beneficial in arresting 
the night-sweats of phthisis, and is an efficient substitute for alco- 
holic stimulants when their use is abandoned. 

Administration. — When taken for its action upon the stomach 
and bowels it should be given before meals ; for its effect on the 
uterus it is best administered in divided doses or the hydrastine 
hydrochlorate hypodermically. 

Cotarnine is a synthetic product from narcotin, and used as a 
styptic and in uterine hemorrhage in -J-grain doses thrice daily or 
oftener. 



DRUGS ACTING CHIEFLY ON THE 
CIRCULATORY ORGANS. 



There is a large group of drugs which, like many of the fore- 
going, show marked pharmacodynamic action on several tissue 
systems of the body, and hence on more than one physiological 
function. Their chief use, however, is to modify, in some definite 
manner, the circulatory apparatus. They either bring about a 
marked regulating action on the rhythm of the heart and act on 
the vessels, as digitalis ; or act almost alone on the blood-vessels, as 
adrenalin or ergot : still others acting purely as reflex stimulants 
to the heart action, as many of the xanthines, or act distinctly 
as cardiac depressants, as aconite. 

These will be here taken up as a series of groups of drugs with 
which one can modify the conditions of the circulation. A large 
number of other factors enter into their full physiological activities, 
but these are laid aside for the moment. 

In this present instance these remedies will be grouped as fol- 
lows : (i) The Digitalis group, composed largely of drugs that exert 
a predominant stimulant action on the vessel walls, on the heart 
walls, and on the cardio-inhibitory apparatus ; (2) Adrenalin-ergot 
group, in which the chief activity is exerted on the tissues of 
the walls of the blood-vessels ; (3) The Xanthine or Caffeine 
group ; (4) the Nitrite group, in which the main action consists 
of vessel dilatation ; and (5) the Aconite group, in which heart- 
muscle and heart-ganglion depression are prominent and vasodilata- 
tion is pronounced. 

It is preferred to eliminate the terms cardiac stimulants, cardiac 
depressants, etc., as cheap catch-phrases, hoping that the student 
should have in mind the general agents at his command to regu- 
late the circulation, if such regulation is called for in treatment. 
As opportunity offers, the circulatory action of a number of the 
drugs already discussed under other headings will be considered. 
Thus, while alcohol exerts its main action on the nervous system it 
plays an immensely important role as a remedy to modify cardiac 
and circulatory activity. 

THE DIGITALIS GROUR 

In this group are classed Digitalis purpurea, Strophanthus Kombe \ 
and vS. hispidns, Convallaria majalis, Urginea Scilla, Helleborus niger, 
Apocynum cannabinum, Adonis vemalis, Nerium oleander, Erythro- 
phlceum Guinense, and a few others. 

235 



236 A TEXT-BOOK OF MATERIA MEDICA. 

It is noteworthy that the active principles in these drugs are 
glycosides, and while their chemical composition may vary consid- 
erably, their pharmacological actions are very similar. 

Digitalis— Digitalis— Digitalis. U. 8. P. 

(Fox-glove.) 

Origin. — The dried leaves of Digitalis purpurea L., collected from plants of the 
second year's growth at the commencement of flowering. The plant is a biennial, 
2 to 5 feet (0.6-1.5 M. ) high, indigenous in Southern and Central Europe, and grow- 
ing wild as far north as Norway. It is also found in Madeira and the Azores, and is 
well known everywhere as an ornamental garden plant. 

Description and Properties. — From 4 to 12 inches (10-30 Cm.) long, 
ovate or ovate-oblong, narrowed, with a petiole, crenate, dull green, densely and finely 
pubescent, wrinkled above, paler and reticulate beneath, midrib broad near the base ; 
odor slight, somewhat tea-like ; taste bitter, nauseous. The leaves of mullein, Inula 
coryza and Inula Helenium, are sometimes mixed with those of fox-glove. 

The study of the active principles is fraught with much difficulty, and at the present 
time it is by no means certain what all of the active bodies are. The following are 
among the most important constituents : Digitalin, C 35 H 56 14 , a crystalline glycosidal 
substance, insoluble in water. Digitalin is found mostly in the seeds. Digitonin, 
C 2T H 48 O u , is another constituent found in greater abundance in the seed, but also 
present in the leaves. It is a white, powder-like glycoside resembling saponin. It is 
soluble in water and insoluble in alcohol. A watery solution is capable of holding 
the water-insoluble glucosides in solution or in suspension. It is an active diuretic 
principle ; digitcxin, C 35 H 54 O n , is the chief glycoside of the leaves and the most active 
constituent of the plant. It is insoluble in water, soluble in alcohol, chloroform, and 
ether; digitophyllin, C 32 H 52 Cy is another glycoside derived from the leaves. It 
resembles digitoxin. Digitalein and digitin are also present, but are of less importance. 

Dose. — 2-2 grains (0.03-0.12 Gm.) [1 grain (0.065 Gm.), U. S. P.]. 

Official Preparations. 

Extractum Digitalis— Extracti Digitalis— Extract of Digitalis.— Dose, \-\ 
grain (0.01-0.03 Gm.) [i grain (0.01 Gm.), U. S. P.]. 

Fluidextractum Digitalis— Fluidextracti Digitalis— Fluidextract of Digi- 
talis.— Dose, \-l minims (0.03-0.12 Cc. ) [1 minim (0.05 Cc), U. S. P.]. 

Infusum Digitalis— Infusi Digitalis— Infusion of Digitalis (i£ per cent.).— 
Dose, 1-4 fluidrams (3.7-15 Cc. ) [2 drams (8 Cc), U. S. P.]. 

Tinctura Digitalis— Tincturse Digitalis— Tincture of Digitalis (10 percent.). 
—Dose, 5-20 minims (0.3-1.2 Cc.) [15 minims (1 Cc), U. S. P.]. 

Unofficial Preparations. 

Digitalinum— Digitalini— Digitalin.— Description and Properties.— -An amor- 
phous, yellowish-white, crystalline powder or scales, or light, white crystalline tufts of 
needles, odorless and of an intensely bitter taste. Insoluble in water, soluble in 
alcohol.— Dose, ^ A grain (0.0006-0.002 Gm.). 

Digitoxin— Digitoxin— Digitoxin.— Description and Properties.— A white crys- 
talline body, of a bitter taste; insoluble in water, soluble in chloroform. — Dose, T -J a - 
Tffff grain (0.0003-0.0006 Gm.). 

Physiological Action. — Externally and Locally. — Digitalis is at 

first irritant to the skin and mucous membrane. Later it may 
paralyze the sensory end-organs and thus prove an analgesic. 
Digitoxin seems to be the most active constituent in causing the 
irritant action. 

Internally.— Digestive System.— Small doses ordinarily produce 
no effect upon the stomach. Large doses act as a gastro-intestinal 



THE DIGITALIS GROUP. 337 

irritant, exciting nausea, vomiting, and diarrhea. These effects may 
follow the prolonged administration even of small doses. Digitalis 
is freely absorbed, although slowly. It usually requires from a 
half to three-quarters of an hour for the effects to become distinct. 
The chief activity is exerted on the circulation apparatus, but the 
nervous system is both primarily and secondarily affected. 

Nervous System. — This is primarily and markedly stimulated. 
In small doses this action is limited to the medulla in the inhibitory 
cardiac and vasoconstrictor centers ; large doses cause a more 
extended medullary excitation, with nausea and vomiting, convul- 
sions, and increased respirations ; toxic doses induce central motor 
convulsions, which are not due to cerebral anemia, since they may 
develop while the circulatory blood-supply is ample. 

Circulatory System. — The principal effects of digitalis are upon 
the circulatory apparatus, the action of the drug varying according 
to the size^f the dose. 

In discussing the action of digitalis on the circulatory apparatus, 
both the results on the heart and on the blood-vessels need con- 
sidering. So far as the heart is concerned two important factors 
should be borne in mind : the heart-muscle itself, and the cardiac 
regulating apparatus, particularly the vagus inhibitory action. 
Digitalis, as well as all the members of the series, exerts a mark- 
edly irritant action on heart-muscle ; it also acts, as has been 
pointed out, as a distinct primary irritant and stimulant to the 
medulla, hence on the vagus nucleus. There is a play between 
these two factors, and the effects of digitalis on the heart are to be 
interpreted in accordance with the respective influences of these 
two conditions. 

Very small doses of digitalis show practically only the results 
of mild muscle-stimulation. They cause, particularly in suscep- 
tible individuals, a slight increase in the force and rapidity of the 
heart-action. 

Larger doses, and especially when repeated, bring out the so- 
called " therapeutic action " of digitalis. As the heart-muscle 
feels the stimulation before the vagus center is affected, there is 
usually, under medicinal doses, a preliminary increase in the 
rapidity of the heart's action, as well as a distinct increase in its 
force. In from three-quarters to one hour after giving a medicinal 
dose the second factor, inhibition, from vagus stimulation, becomes 
apparent; in some cases it may take several hours fully to estab- 
lish the vagus action ; then the heart-rhythm becomes slower, the 
force is increased, the systole is more complete and effective, and 
usually a larger amount of blood is being pumped every hour 
throughout the body, and also into the body of the heart-muscle 
itself. 

This condition of increased tone may be held by judicious use 
of digitalis for considerable periods of time. Should the limit of 
safe dosage, however, be overstepped, the poisonous action of 
digitalis may appear. This poisonous action has been interpreted 



238 A TEXT-BOOK OF MA TERIA MEDICA. 

in a variety of ways, but it would appear that two explanations 
alone are tenable, perhaps only one. It has been held that one of 
the first results of poisoning is a partial paralysis of the vagus 
center, this would let up on the inhibitory rein on the heart and it 
would commence to beat faster, being still stimulated as to its 
muscle ; further loss of inhibitory control would cause arhythmia, 
and the end result would be a rapid, irregular heart with loss of 
tone and final exhaustion. 

It has been shown, however, in some instances, and these are 
yet too few to be positive concerning the matter, that artificial 
vagus stimulation is effective in slowing the heart even in the last 
stages of poisoning. Should this be interpreted that the vagus 
centers are not exhausted by digitalis, in order to explain the 
symptoms noted, it must be assumed that the muscle stimulation 
has become so excessive that even the vagus inhibition is ineffectual 
in controling it, hence the rapid irregular heart-action is a result of 
intense muscle irritability brought about by the members of this 
series. According to this view there is, in the final stages of 
poisoning, a distinct delirium cordis set up which the vagus inhi- 
bition is unable to control. This brings about the arhythmia, loss 
of efficient contractions, and finally exhaustion with marked dias- 
tolic relaxation. 

The action of digitalis on the blood-vessels is marked. It 
causes in therapeutic doses a distinct stimulation of the vasocon- 
strictors with an increase in the arterial tension. An action on the 
muscles of the arteries themselves augments this central action, 
probably antedates it. In poisoning the blood-pressure usually 
falls, but it is apt to be extremely irregular ; final toxic stages are 
invariably accompanied by loss of pressure, both in the interior 
and in the extremities. 

Kidneys. — Digitalis was introduced into modern practice because 
of its action as a diuretic. 

This diuretic action is due largely to the increase of blood- 
pressure in the glomeruli of the kidneys, being therefore more pro- 
nounced in conditions in which low arterial pressure is main- 
tained at the same time. Very large doses, instead of increasing 
the amount of urine, may diminish or even wholly suppress it. 

Temperature. — Medicinal amounts have no appreciable effect 
upon the temperature ; large doses cause a reduction of bodily 
heat in febrile conditions, while toxic doses reduce temperature 
even in health. The action of digitalis upon the circulatory system 
is retarded by high temperature. 

Eye. — Medicinal amounts have no effect. Large or poisonous 
doses may cause dimness of vision, amblyopia, diplopia, or mydri- 
asis. In a case of poisoning by digitalis recorded by Jcanton there 
was xanthopsia for two days. 

Uterus. — Larn;e doses stimulate contraction in the uterine 
muscles. 

Absorption and Elimination. — Digitalis is more rapidly absorbed 



THE DIGITALIS GROUP. 239 

than eliminated, the elimination probably taking place by the kid- 
neys. Cumulative action, so called, is therefore to be expected with 
digitalis. 

Metabolism. — This is increased by reason of the increase in the 
general circulation. With increased blood-pressure the amount of 
nitrogen elimination is increased, as is also the quantity of C0 2 
given off. If the blood-pressure is not raised by the drug the 
increase of these is not noted. 

Untoward Action. — Erysipelatous and papular eruptions have 
been produced by the drug, there having been also observed 
nausea and a feeling of weakness in the stomach, dimness of vision, 
headache, heaviness of the head, sleeplessness, and debility. 

Poisoning. — Toxic symptoms may occur either from the inges- 
tion of a single poisonous dose or the accumulation of the drug 
under prolonged administration. 

In the more marked cases of poisoning from overdosage there 
are marked disturbances of the gastro-intestinal tract, abdominal 
pains, vomiting and purging. The pulse may at first be slowed 
down to 40, to be followed in the stage of collapse by a rapid, 
irregular, and compressible pulse — often imperceptible at the wrist 
— and syncope, more frequently occurring when the patient is 
raised up. 

Other symptoms are — feeble respiration, dilated pupils and 
occasionally double vision, headache, delirium and stupor, and 
possibly convulsions just before death, which result from medullary 
excitation. Digitalis is not a rapid poison, the fatal collapse being 
usually deferred from ten to forty-eight hours. 

The symptoms indicative of the cumulative action of digitalis 
are usually gastric irritability, headache, and dizziness. These are 
associated with a feeling of fulness in the vessels, particularly in 
the temples, by weakness in the pit of the stomach, and by a tend- 
ency to syncope. There may also be ringing and buzzing in the 
ears, and disturbances of sight and hearing. 

Poisonous doses are difficult to determine. One teaspoonful of 
the leaves, as an infusion, and 40 grains of the powder, have caused 
death, whereas ten times as much in infusion and 80 grains of the 
powder have not produced fatal results. The extract in 20-grain 
doses has been lethal, as have also 2 ounces of the tincture. Digi- 
toxin in -^ grain (.002 Gm.) has been deadly, and the commercial 
digitalins have caused serious results in doses of from J— 1 grain 
(.030-060 Gm.). 

Treatment of Poisoning. — Lavage of the stomach should be 
immediate, emetics being too depressing if the heart is already 
affected by the poison. A solution of tannic acid should be intro- 
duced into the stomach as the best chemical antidote. Diffusible 
stimulants may be required, the horizontal position should be 
maintained, and external heat applied, particularly to the abdomen. 
Absolute rest is imperative. The patient should not be allowed 
even to raise his hand or his head from the bed. 



240 A TEXT-BOOK OF MA TERIA MEDICA. 

Therapeutics. — Externally and Locally. — Digitalis is of little 
service externally. 

Internally. — Digitalis is one of the most important drugs known 
to medicine. The remedy is indicated in deranged conditions of 
the circulatory system itself, and, moreover, where, although the 
circulatory mechanism be normal, an abnormal state of other organs 
may be improved by changing the circulation in them. Digitalis 
is indicated in any case where there is actual failure in the dynamic 
power of the heart-muscle, irrespective of the nature of any primary 
valvular lesion inducing the hyposystolic condition. 

Of course the rational use of the drug presupposes the absence 
of extensive fatty degeneration or interstitial myocarditis, since, 
should these conditions be advanced, there is danger of producing 
permanent asystole. It is difficult to estimate the integrity of the 
heart-muscle, and many cases presumably intolerant of the drug 
bear digitalis well. 

In all conditions, therefore, in which there is insufficient driving 
power in the muscle with the usual accumulation of blood in the 
veins, digitalis is useful. As it improves the blood-supply of its 
own fibers it therefore aids in restoring tone to itself, and may even 
so increase its own power as to render the drug unnecessary. 

With regard to the specific effect of the drug upon the heart- 
muscle this is not true, since the influence of the drug lasts but 
a few days, indirectly, through the additional muscle-power devel- 
oped during a few weeks' administration. During or after middle 
life, if the vascular tension be increased, and especially if there be 
any sclerosis of the vessels, the administration of digitalis should 
be combined with that of vasodilators, to prevent contraction of 
the vessels and consequent increase of peripheral resistance. Of 
these adjuncts, the nitrites (nitroglycerin) are the most valuable. 
Opium in small doses is also of service. 

In mitral regurgitation digitalis is an exceedingly efficient 
remedy. In this not infrequent lesion there is a deficiency of 
blood in the systemic arteries, and consequently an overaccumula- 
tion in the pulmonary vessels and systemic veins. Owing to this 
venous hyperemia, there is congestion of the lungs, stomach, liver, 
and the entire digestive tract, together with the attendant symp- 
toms — dyspnea, bronchitis, deranged digestion, constipation, edema, 
etc. 

Digitalis by improving the pumping power of the heart equalizes 
the circulation, fills the systemic arteries, and relieves the venous 
congestion with its accompanying symptoms. 

Digitalis is valueless in the presence of compensatory hyper- 
trophy, but after dilatation occurs is wonderfully effective, the size 
of the heart being often perceptibly diminished by a proper admin- 
istration of the drug. 

Digitalis may act indirectly as a tonic by improving the nutri- 
tion of the heart through the prolonged diastole and contraction of 
the cardiac muscle it occasions. The longer the period of diastole, 



THE DIGITALIS GROUP. 241 

the more time is allowed for the coronary arteries to fill and nourish 
the heart by the better blood-supply. The increased arterial ten- 
sion produced by the drug causes the blood to be sent into the 
coronary arteries with greater force during the cardiac diastole. 

The forcible contraction of the heart occasioned by this drug 
expels the blood from the veins of the cardiac muscle, improved 
nutrition of the muscle resulting from this mechanical action. 

In many valvular diseases of the heart there is marked irregu- 
larity, such often being more serious than the mere leakage of 
blood. Digitalis by stimulating the vagus and motor ganglia causes 
the heart to beat more regularly. The drug is, therefore, of great 
service in exophthalmic goiter. 

In any condition of low arterial tension, whether resulting from 
infection, general debility, or whatever cause, digitalis, by increasing 
the force of the heart and raising arterial pressure, serves a useful 
purpose. 

In collapse from shock, poisoning, or cholera, where the great 
veins are dilated, it has proved an efficient agent, but it must be 
used in conjunction with more active and quick stimulants, such as 
alcohol, ether, nitrites, etc. 

The functional activity of the various organs in anemia and other 
deranged conditions of the system may be improved by the admin- 
istration of this remedy. 

The circulation being improved, there is increased absorption of 
fluid from the tissues, as well as greater circulation of fresh inter- 
cellular fluid, favoring combustion and functional activity, while the 
waste products are more readily removed. This action renders 
digitalis valuable as a tonic. 

In pneumonia, particularly if there is an irregular, fluttering 
heart, and evident signs of toxic action, it is of the greatest import- 
ance, being of use here to stimulate the contractile force of the 
cardiac muscle when the intraventricular pressure becomes stronger 
than the unaided muscle can resist, and dilatation is imminent, if not 
already begun. 

In congestion of the lungs during the course of exhausting fevers, 
such as typhoid, and in the first stage of meningitis, bronchitis, cellu- 
litis, etc., before transudation takes place, it is considered by many 
physicians to be a valuable, remedy in relieving the venous stasis. 
It is particularly valuable, combined with squill, in many cases of 
chronic bronchitis, particularly of cardiac origin. 

Many observers of wide experience have recommended large 
doses of digitalis in delirium tremens. It is wonderfully effective in 
this condition, particularly where there is low arterial pressure. 
Small doses are more beneficial than large ones. 

Digitalis has been successfully employed in acute mania and 
epilepsy, Gowers recommending it in the latter disease as an adju- 
vant to the bromides, associated with belladonna. It is fair to state 
that in maniacal conditions the preponderance of testimony is in 
favor of large doses — \ to 4 fluidrams (1.8- 15.0 Cc.) of the tincture. 

16 



242 A TEXT-BOOK OF MA TERIA MEDICA. 

The drug is thought to enhance the influence of ergot in post- 
partum hemorrhage ; and when associated with iron it is of value in 
purpura hemorrhagica. 

The drug, combined with ergot or potassium bromide according 
to the indications, has been successfully employed in spermatorrhea, 
and nocturnal emissions. 

It is said that absorption of pleuritic effusion is hastened by the 
continued administration of digitalis. 

Clifford Allbutt recommends it in sufficient doses to reduce the 
pulse to 45 or 50 in aneurism. This method of treatment, however, 
has not been widely adopted. 

The remedy is invaluable as a diuretic to relieve cardiac or renal 
dropsy, its efficiency being more apparent in the former variety, 
although acute renal dropsy usually yields to its influence. Digi- 
talis, especially combined with squills, is particularly valuable in all 
dropsies accompanied by lowered arterial tension. Should the 
renal structure be impaired, the drug is less serviceable, although, 
when combined with other appropriate remedies, it is decidedly 
beneficial in clironic Bright' s disease with cardiac dilatation. In the 
early stages of the malady, accompanied by cardiac hypertrophy 
and high arterial tension, it is doubtful whether digitalis is indicated, 
either alone or in combination. 

In conclusion, it should be stated that digitalis is recommended 
by all authors in every valvular disease of the heart, with the pos- 
sible exception of aortic regurgitation, some writers supposing it to 
be harmful in this condition because of the prolonged diastole it 
occasions. The more recent clinical views would seem to show 
that even this valvular affection is not a contraindication. 

Contraindications. — Digitalis should not be given when there 
is marked degeneration of the heart-muscle or of the arterial 
walls. In simple hypertrophy, apoplexy, high arterial pressure, 
or vascular excitement the use of the drug is inadvisable. Many 
physicians regard aneurism as a contraindication to the use of 
digitalis. 

Administration. — Any of the official preparations may be given, 
or the powdered leaves in pills or capsules — not at too frequent 
intervals, however, from four to eight hours elapsing between the 
doses, lest the drug accumulate in the system, producing poisonous 
symptoms. 

When digitalis has been administered for some time to a patient 
suffering from ascites, and the fluid is removed by paracentesis, 
poisoning may ensue. It is well, therefore, to discontinue the 
remedy for two or three days before tapping the patient. 

The rapidity of the drug's action upon the heart depends upon 
the presence or absence of a febrile state. The stimulant action 
upon the heart is usually observable in from twenty-four to thirty- 
six hours. The effects of the drug commonly continue from three 
to seven days after its discontinuance. 

The powdered digitalis, though the most irritant to the stomach, 



THE DIGITALIS GROUP. 243 

fully represents the drug, which is true of none of the prepara- 
tions. 

The infusion of digitalis, being an aqueous preparation and con- 
taining, therefore, a larger proportion of digitonin, is superior for 
diuretic purposes ; while the alcoholic preparations, like the fluid- 
extract and tincture, being richer in digitalin, digitalein, and digi- 
toxin, are preferable when an action upon the heart is desired. 

Ordinarily, therefore, digitalis should be given in solution, the 
tincture and infusion being the most reliable preparations ; care 
being taken in the selection of the crude drug, upon the character 
of which the strength of the preparation depends. 

In uncomplicated cases of cardiac failure, the result of valvular 
lesion, the tincture is most eligible. In cardiac failure associated 
with, or resulting from, kidney lesions the infusion, combined with, 
some other diuretic, should be used. 

Strophanthus— Strophanthi— Strophanthus. 

V. S. V. 

Origin. — The ripe seed of Strophanthus Kotnbe Oliver, deprived of its long awn. 
The plant is a woody climber, ascending to the tops of high trees, from which it hangs 
in festoons. It is found in tropical Africa, where it and other species of strophanthus 
are used to prepare arrow-poisons termed ko7nbe, Inee, Inege, etc. 

Description and Properties. — The seeds are about }( inch (15 Mm.) long 
and i to i inch (4-5 Mm.) broad, oblong-lanceolate, flattened and obtusely-edged, 
grayish-green, covered with appressed silky hairs, one side extending into the attenu- 
ated, pointed end ; kernel white and oily, consisting of a straight embryo having two 
cotyledons, and surrounded by a thin layer of perisperm ; nearly inodorous ; taste very 
bitter. 

Many of the species of strophanthus contain a glycoside, strophanthine upon which 
their medicinal properties depend. Feist has also isolated a pseudostrophanthin. Stroph 
anthidin is also described as a separate glycoside found in some of the seeds. It 
also contains kombic acid. Another active principle, ouabain, is obtained from a related 
species of strophanthus. 

Dose. — I grain (0.065 Gin.), U. S. P. 

Official Preparation. 

Tinctura Strophanthi — Tincturse Strophanthi — Tincture of Strophanthus 
(10 per cent.). — Dose, 2-10 minims (0.12-0.6 Cc. ) [8 minims (0.5 Cc), U. S. P.]. 

Strophanthinum— Strophanthini— Strophanthin. 

U. S. P. 

Definition. — A glycoside, or mixture of glycosides, obtained from strophanthus. 

Description and Properties. — Strophanthin is a white or faintly yellowish 
crystalline powder. It is permanent in the air and has an intensely bitter taste. It is 
very soluble in water and diluted alcohol. Its solutions decompose very readily. ' 

Dose. — Average dose : ^i^ grain =0.0003 Gm. (0.3 milligramme), U. S. P. 

Physiological Action. — Externally and Locally. — The tincture 
of strophanthus has no local action of importance. Strophanthin 
and ouabain, however, possess marked sedative properties, the 
latter being much the stronger. They paralyze the ends of the 
sensory nerves and are active local anesthetics. 

Internally. — Digestive System. — Strophanthus is similar in its 



244 A TEXT-BOOK OF MATERIA MEDICA. 

action to digitalis, though less apt to disturb digestion in small 
doses ; on the contrary, its bitter taste tends to improve the appetite. 

Nervous System. — Strophanthus affects the nervous system even 
less than digitalis. Kobert claims that it is a slight sedative to the 
brain and spinal cord. 

Circulatory System. — Upon the heart its action is identical with 
that of digitalis, though differing from the latter drug in its effect 
upon arterial tension and the arterioles. Strophanthus does not 
contract the arterioles so markedly, and the arterial pressure is but 
slightly raised, the elevation being due to the increased force of the 
heart. Its action is more rapid than that of digitalis, fifteen to 
twenty minutes after taking causing results. 

Respiratory System. — It has no important action. 

Absorption and Elimination. — Strophanthus is rapidly absorbed, 
and more readily eliminated than digitalis, possessing less cumula- 
tive action. It is principally excreted by the kidneys, increasing 
the amount of urine by the strengthened heart's action. Unlike 
digitalis, the drug has little influence upon the caliber of the renal 
vessels. 

Temperature. — Very large doses of strophanthus cause a slight 
reduction of temperature, not, however, as marked as digitalis. 

Eye. — Excessive doses contract the pupil and increase intra- 
ocular tension. 

Uterus. — It resembles digitalis, though more feeble in its action 
upon the uterus. 

The symptoms and treatment of poisoning are similar to those 
described under Digitalis, although strophanthus is more apt to 
occasion diarrhea. Cases of poisoning are rare. The symptoms 
observed have been those of severe digitalis poisoning with uncon- 
sciousness, tonic and clonic convulsions, hallucinations, diarrhea, 
analgesia, myosis, Cheyne-Stokes respiration, and death after four 
days. The toxic dose has not been determined. 

Therapeutics. — Externally and Locally. — Strophanthin has 
been occasionally employed as a local anesthetic, but the testimony 
in its favor is hardly sufficient to encourage its use. 

Internally. — Strophanthus is a cardiac remedy, being indicated 
in the same varieties of heart disease as digitalis. It is of particular 
value in stenosis of the mitral orifice, having a happy influence in 
controlling the irregular rhythm, nervous dyspnea, and intermittent 
pains distinctive of this lesion. The drug is also well adapted in 
subduing functional irregularities of rhythm in cases of irritable or 
tobacco heart. 

Hypothetically, strophanthus is superior to digitalis in certain 
stages of Bright s disease and heart failure of elderly people with 
slightly degenerated arteries, especially in those patients with pre- 
existing high arterial tension. It is also hypothetically of greater 
value in pneumonia than digitalis. 

Shoemaker advocates the use of strophanthus in the treatment 
of psoriasis. 



THE DIGITALIS GROUP. 245 

While in the majority of cardiac diseases digitalis should be 
first tried, where it fails strophanthus is the proper recourse. It is 
a peculiarly efficient drug in the cardiac diseases of children, accord- 
ing to the majority of observers being safer than digitalis for young 
patients. 

Contraindications. — The same as for digitalis. 

Administration. — Of the preparations of strophanthus, the 
tincture is preferable, both for convenience and safety. It should 
not be forgotten, however, that the seeds of strophanthus that 
come into the American market are very much mixed, and that 
many preparations are not as reliable as one would hope for. 
Should strophanthin or ouabain be desirable, a fresh solution is 
to be preferred. 

Convallaria— Convallariae— Convallaria. 77. S. -P. 

(Lily of the Valley.) 

Origin. — The dried rhizome and roots of Convallaria majalis L., a stemless per- 
ennial indigenous in Europe, Northern Asia, and North America. 

Description and Properties. — Of horizontal growth and somewhat branched, 
about y% inch (3 Mm.) thick, cylindrical, wrinkled, whitish, marked with a few circu- 
lar scars ; at the annulate joint with about eight or ten thin roots ; fracture somewhat 
fibrous, white ; odor peculiar, pleasant ; taste sweetish, bitter, and somewhat acrid. 

Convallaria contains two glycosids : convallamarin and convallarin. 

Official Preparation. 

Fluidextractum Convallariae — Fluidextracti Convallariae — Fluidextract of 
Convallaria. — Dose, 5-30 minims (0.5-2 Cc.) [8 minims (0.5 Cc), U. S. P.]. 

Physiological Action. — Almost identical with that of digitalis, 
but less powerful and possessing no cumulative action. Prepara- 
tions free from convallarin do not disturb the stomach nor affect 
the cerebrospinal functions. It is asserted that convallaria has 
stronger diuretic properties than digitalis. 

Convallamarin in some cases has produced, among other unto- 
ward symptoms, hemoptysis and dyspnea. 

Convallarin is a drastic purgative, and in full doses occasions 
nausea and gastric pain. 

Therapeutics. — Convallaria is used for precisely the same pur- 
poses as digitalis. The only advantage it possesses over the latter 
drug is that it has no cumulative action. By some physicians it is 
considered superior to digitalis as a diuretic and cardiac stimulant 
after failure of compensation, the diuresis it occasions persisting for 
some time after the withdrawal of the drug. 

Contraindications. — The same as for digitalis. 

Administration. — The fluidextract is the best preparation to 
use, although the infusion is highly recommended by many physi- 
cians. 



246 A TEXT-BOOK OF MATERIA MEDICA. 

Scilla— Scillae— Squill. U. 8. JP. 

Origin. — The bulb of Urginea maritima (L.) Baker, a plant indigenous in the 
basin of the Mediterranean, from Syria westward to the coast of the Atlantic. The 
bulb is deprived of its dry, membranaceous outer scales and cut into thin slices, the 
central portions being rejected. 

Description and Properties. — Occurring in narrow segments about 2 inches 
(5 Cm.) long, slightly translucent, yellowish- white or reddish, brittle and pulverizable 
when dry, tough and flexible after exposure to damp air ; inodorous ; taste mucilagi- 
nous, bitter, and acrid. Merck isolated three active glycosides — scillipicrin, scillitoxin 
(both acting upon the heart), and scillin (an emetic principle) — together with various 
unimportant substances, such as mucilage, sugar, etc. Jamerstedt's scillain has 
been held to be identical with Merck's scillitoxin. 

Dose. — 1-4 grains (0.06-0.25 Gm.) [2 grains (0.125 Gm.), U. S. P.]. 

Official Preparations. 

Acetum Scillae — Aceti Scillae — Vinegar of Squill (10 percent.). — Dose, 10-30 
minims (0.6-2.0 Cc.) [15 minims (1 Cc), U. S. P.]. 

Fluidextractum Scillae — Fluidextracti Scillae — Fluidextract of Squill. — 
Dose, 1-4 minims (0.065-0.25 Cc.) \\\ minims (0.1 Cc), U. S. P.]. 

Syrupus Scillae — Syrupi Scillae — Syrup of Squill (45 per cent, of the Acetum). 
— Dose, 30-60 minims (2.0-4.0 Cc.) [30 minims (2 Cc), U. S. P.]. 

Syrupus Scillae Compositus — Syrupi Scillae Compositi — Compound Syrup 
of Squill. Fluidextract 8 per cent., with fluidextract of senega 8 per cent., and 
tartar emetic 0.2 per cent., or \ grain (0.008 Gm.) to I fluidrachm (4.0 Cc). — Dose, 
15 minims to 2 fluidrachms (1. 0-8.0 Cc) £30 minims (2 Cc), U. S. P.]. 

Tinctura Scillae — Tincturae Scillae — Tincture of Squill (10 per cent). — Dose, 
5-20 minims (0.3-1.3 Cc) [15 minims (1 Cc), U. S. P.]. 

Antagonists and Incompatibles. — The action of squill upon 
the circulatory system is antagonized by the cardiac depressants. 
Tannic acid is incompatible. 

Synergists. — The diuretic action of squill is enhanced by the 
diuretics and many of the cardiac stimulants. As an expectorant 
the drug is aided by senega and tartar emetic. 

Physiological Action. — Externally and Locally. — There is no 
action of special importance. Applied to mucous membranes, how- 
ever, squill acts as an irritant. 

Internally. — Digestive System. — Large doses of the drug excite 
nausea, vomiting, and purging. Excessive amounts may produce 
gastro-enteritis. 

Nervous System. — Squills has little action on the nervous system 
in medicinal doses. 

Circulatory System. — The action of squill upon the heart and 
blood-vessels resembles that of digitalis, although as a cardiac stimu- 
lant digitalis is the more powerful. 

Respiratory System. — The bronchial mucus is increased and ex- 
pectoration facilitated by small doses of squill. Toxic doses render 
the respiration rapid and shallow. 

Absorption and Elimination. — The active principles of squill are 
quickly diffused through the blood, being eliminated chiefly by the 
kidneys and bronchial mucous membrane. 

In the passage of squill through the kidneys the renal epithelium 
is stimulated by the drug, which influence, together with the drug's 
action upon the systemic circulation, renders squill an active and 



THE DIGITALIS GROUP. 247 

valuable diuretic, increasing not only the amount of urine, but also 
the quantity of inorganic solids. 

Very large doses irritate and inflame the kidneys, resulting in 
strangury and hematuria, with occasionally entire suppression of 
urinary flow. 

Untoward Action. — This does not differ essentially from the 
symptons of " Poisoning." 

Poisoning. — In toxic doses squill acts as an acrid narcotic poison. 
The symptoms produced by excessive doses are — nausea, violent 
vomiting, serous and bloody diarrhea, severe griping, a sensation 
of burning in the throat, vesical tenesmus accompanied by pain, 
bloody urine, and, perhaps, entire suppression of the urinary flow. 
The pulse is feeble and slow or sometimes rapid, the symptoms 
terminating in collapse and death, occasionally preceded by convul- 
sions. The death of a child three to five years of age has occurred 
from the taking of a half-teaspoonful of the syrup of squill. 

Treatment of Poisoning. — The stomach should be evacuated and 
demulcent drinks freely given. Opium may be necessary to relieve 
pain, while diffusible stimulants serve to counteract cardiac and 
respiratory depression. Otherwise as in digitalis poisoning. 

Therapeutics. — Squill is not used externally and locally. It has 
been employed internally as a diuretic in dropsy. When associated 
with digitalis and calomel it is an exceedingly active diuretic in 
cases of cardiac dropsy, chronic pleurisy, and pericarditis with effu- 
sion. 

Squill is an efficient expectorant, the vinegar, syrup, and com- 
pound syrup of squill being useful preparations in subacute and 
chronic forms of bronchitis, particularly when the sputum is tenacious 
and expelled with difficulty. 

Contraindications. — Squill should not be employed in cases of 
acute diseases of the kidneys. It is also inadmissible in acute 
bronchitis and in phthisis. 

Administration. — Any of the preparations of the drug may be 
given, to be prescribed well diluted with syrup or glycerin. 

Inasmuch as the diuretic action of squill ceases after a while, 
the doses should be repeated and gradually enlarged until some 
untoward action intervenes, when further increase should be sus- 
pended. 

Because of its too-irritating properties the drug is seldom given 
alone when desired for its diuretic action. 

Owing to the free acetic acid which it contains, syrup of squill is 
incompatible with ammonium carbonate and other alkalies. 

Adonis Vernalis— Adonidis Vernalis— False 
Hellebore. (Non-official.) 

Origin. — A perennial herb attaining a height of about 10 inches (25 Cm.), in- 
digenous in Europe. 

Description and Properties. — It has but little odor and a somewhat acrid 
and bitter taste. The plant contains a glycosid, adonidin, to which it owes its medicinal 



248 A TEXT-BOOK OF MA TERIA MEDICA. 

properties. This constituent is a light-colored, crystalline powder, of a bitter taste, 
and soluble in water and alcohol. A Japanese species, Adonis amurensis, yields a 
related glycosid, Adonin. 

Dose of Adonidin. — £$-\ grain (0.003-0.01 Gm.). 

Antagonists, Incompatibles, and Synergists. — The same as 
for digitalis. 

Physiological Action and Therapeutics. — The action of adoni- 
din is similar to that of digitalis, save that it is less cumulative. 

It is used for the same purposes as digitalis, being peculiarity 
valuable in relieving the pains of heart disease, and is by some 
physicians preferred to digitalis in the treatment of aortic and mitral 
insufficiency, cardiac asthma, and functional irregularity of the heart. 

Erythrophleum— Erythrophlei— Erythrophleum. 
(Non-official.) 

(Casca Bark.) 

Origin. — A glycosid obtained from the bark of Erythrophloetim Guineense Don, 
known under the names of Casca bark, Sassy bark, and Ordeal bark. The tree is a 
native of West Africa, the plant being used by the natives as an ordeal in witchcraft. 

Description and Properties. — Erythrophlein hydrochloride, the salt usu- 
ally employed, occurs in the form of whitish crystals, soluble in water. 

Dose. — gV-TS § rain (0.01-0.005 Gm.). 

Physiological Action and Therapeutics. — The powdered bark 
when inhaled causes violent sneezing. The tincture of the bark, 
or the glycosid, when taken in poisonous doses occasions nausea, 
vomiting, purging, intense headache, intoxication, convulsions, and 
death. 

In medicinal doses the drug affects the circulatory system after 
the manner of digitalis, and acts upon the kidneys as an active 
diuretic. It was at one time supposed to be a powerful local anes- 
thetic ; further examination, however, has proved the claim to be 
unfounded. 

Casca bark or its glycosid has been employed in intermittent fever, 
diarrhea, dysentery, and dyspepsia. Its chief medical uses are in 
valvular disease of the heart and as a diuretic in cardiac and renal 
dropsies. 

Administration. — A tincture of the bark (10 per cent, strength) 
maybe given internally, diluted with water, in doses of 5 to 10 minims 
(0.3-0.6 Cc). Erythrophlein hydrochlorate is usually given hypo- 
dermically. 

DRUGS ACTING CHIEFLY AS VASOCONSTRICTORS. 

A number of the group of drugs whose main action is on the 
organs of circulation act, in some respects, like the digitalis group, 
but instead of exerting their main action on the heart-muscle, their 
chief activity is manifest on the arteries and unstriped muscle in 
general. The most important of this series are ergot and the supra- 



DRUGS ACTING AS VASOCONSTRICTORS. 249 

renal extracts. Hydrastis and gossypium may be included in this 
category, but their action is much weaker. 

Ergota— Ergotae— Ergot. 77. 8. -P. 

Origin. — The sclerotium of Claviceps purpurea (Fries) Tulasne (Fungi), re- 
placing the grain of rye, Secale cereale L. Most of the commercial article comes from 
Spain and Russia. 

Description and Properties. — Somewhat fusiform, obtusely triangular, 
usually curved, about § to \\ inches (2-3 Cm.) long and \ inch (3 Mm.) thick ; three- 
furrowed, obtuse at both- ends, purplish-black, internally whitish, with some purplish 
striae, breaking with a short fracture ; odor peculiar, heavy, increased by trituration 
with potassium or sodium hydrate T. S. ; taste oily and disagreeable. Old ergot, 
which breaks with a sharp snap, is almost or entirely devoid of a pinkish tinge in the 
fracture, is hard and brittle between the teeth, and comparatively odorless and tasteless, 
should be rejected. 

Ergot should be but moderately dried and preserved in a closed vessel, with a few 
drops of chloroform added from time to time to prevent the development of insects. 
When more than one year old it is unfit for use. 

The active constituents of ergot are not definitely ascertained. It contains, how- 
ever, an acid soluble in water and variously termed sclerotinic, ergotinic, and ergolic 
acid, and another, soluble in alkalies, known as sphacelic acid. Both of these acids 
possess ecbolic properties. Robert isolated a principle known as cornutine. 30 per 
cent, of a yellow non-drying saponifiable fixed oil, besides proteids, sugar, tannin, and 
ash are also present. The commercial ergotin is merely a purified aqueous extract of 
ergot. 

Jacobj has more recently isolated two bodies : one, sphacelotoxin, which produces 
gangrenous effects, and chrysotoxin, which acts somewhat like Robert's cornutine. 

Dose. — 5-60 grains (0.30-4.0 Gm.) [30 grains (2 Gm.), U. S. P.]. 

Official Preparations. 

Extractum Ergotae — Extracti Ergotae — Extract of Ergot. — Dose, 2-10 grains 
(0.12-0.06 Gm. ) [4 grains (0.25 Gm.), U. S. P.]. 

Fluidextractum Ergotae — Fluidextracti Ergotae — Fluidextract of Ergot. — 
Dose, 15-60 minims (1.0-4.0 Cc.) [30 minims (2 Cc), U. S. P.]. 

Vinum Ergotae — Vini Ergotae — Wine of Ergot. — Dose, 1-3 fluidrachms (4.0- 
12.0 Cc. (2 drachms (8.0 Cc), U. S. P.]. 

Antagonists and Incompatibles. — The cardiac and motor de- 
pressants antagonize the action of ergot. Caustic alkalies and metallic 
salts are chemically incompatible. 

Synergists. — Its action upon the circulation is aided by digitalis 
and belladonna ; upon the nervous system by strychnine ; while 
ustilago, hydrastine, gossypium, and the emmenagogues enhance its 
influence upon the uterus. 

Physiological Action. — Externally and Locally. — Ergot has no 
distinctive action upon the skin, but upon mucous membranes its 
influence is that of an astringent, possessing hemostatic properties. 

Internally. — Digestive System. — In large doses it is a gastroin- 
testinal irritant, occasioning considerable heat and dryness of the 
throat, accompanied by thirst and succeeded by pain in the stomach 
and bowels, vomiting, and occasionally purging, with violent per- 
istalis, although constipation is the commoner sequence. 

Nervous System. — Medicinal doses have no especial action, 
though excessive doses sometimes depress the sensory mechanism, 
producing general cutaneous anesthesia. 



250 A TEXT-BOOK OF MA TERIA MEDICA. 

The action of toxic doses on the nervous system will be described 
under " Poisoning." 

Medulla. — Ergot has a distinct action on the medulla, stimulating 
the respiratory and cardio-inhibitory centers, and acting as a distinct 
stimulant to the vasoconstrictor apparatus. Its action on circula- 
tion is thus marked. 

Circulatory System. — Repeated medicinal doses increase the 
blood-pressure, and render the pulse slower and smaller — the 
result both of stimulation of the vasomotor center, followed by periph- 
eral action on the smooth muscle of the arteries. Jacobj thinks 
that sphacelotoxin is the chief agent in causing the contraction of 
the arteries, and that its activities are exerted both centrally and 
peripherally. 

The heart muscle itself seems to be stimulated secondarily only. 

Respiratory System. — Medicinal doses produce a mild stimulation 
of the respiratory center. 

Absorption and Elimination, — The actual constituents of ergot 
are rapidly absorbed into the blood, and are eliminated principally 
by the kidneys, increasing the urinary flow. 

Temperature. — No special action has been observed. 

Eye. — The caliber of the retinal and nutrient opticus blood- 
vessels is reduced, resulting in marked pallor of the disk, transitory 
amblyopia, and papillary anemia. 

Uterus. — Probably the most important action of ergot is upon 
this organ. It produces in full doses tetanic, tonic contraction of 
the uterine muscle, the uterus becoming hard and pale, and forcing 
the blood out of the uterine arterioles. The organ is more sensi- 
tive to the action of the drug during pregnancy. 

The precise manner in which ergot affects the uterus is still 
a matter of discussion. It is fairly demonstrated, however, that 
the drug acts both centrally and peripherally. 

It is doubtful if any drug in our Materia Medica has been more 
carefully studied than ergot, and, if opinions differ widely as to its 
modus operandi, it is because we have to deal with a very complex 
substance, the nature, and even the number, of whose constituents 
are as yet inadequately known. Many principles of the drug are 
unstable and variable in their action, certain preparations differing 
decidedly from others in their influence, as, for instance, Tanret's 
ergotinine, which has no effect upon the uterus. Bonjean's ergotin 
is a powerful ecbolic, and has a marked action, moreover, upon the 
vascular system, whereas Wigger's ergotin is inert. Robert's cornu- 
tine is probably not a pure principle, and his ergotinic acid is not a 
true principle. Jacobj \s principles are those last isolated. 

Untoward Action. — In addition to the gastro-intestinal disturb- 
ances already described, there are occasionally produced headaches, 
mental confusion, dizziness, a feeling of chilliness, muscular weakness, 
dilatation of pupils, and glimmering before the eyes. 

Poisoning. — There are two varieties of ergot-poisoning, acute 
and chronic. Under the administration of immoderate doses pecu- 



DRUGS ACTING AS VASOCONSTRICTORS. 251 

liar symptoms appear, known collectively as acute ergotism. Rest- 
lessness, mental worry, headache, tinnitus aurium, dilatation of the 
pupils, pallor and coldness of the skin, and other effects are present. 
There is a weak, slow pulse and evident symptoms of respiratory 
failure. At times cutaneous anesthesia is manifest, or general formi- 
cation. There may be disturbances of vision and of hearing. Epi- 
leptiform spasms, great reduction of respiration and temperature 
may occur, while obstruction of cardiac movements, with sudden 
nausea, salivation, violent vomiting, and intense diarrhea, and other 
alarming manifestations, attest the untoward properties of the drug. 
In pregnant women colic, abortion, and hemorrhage may occur. 
Death may take place at the end of about twenty-four hours, but the 
dose must be enormous. Sixty grains of ergot have produced very 
severe symptoms. As most of the acute poisonous cases have been 
complicated by abortion and hemorrhage, the lethal dose is difficult 
to estimate. Proportions of over 2 per cent, of ergot in rye flour may 
cause acute intoxication. 

Chronic ergotism is confined chiefly to Europe, where ergotized rye 
is used in bread-making. The disease is marked by convulsive or 
grangrenous conditions. Numerous irregular types are observed. 

The first variety, the convulsive, is characterized by paroxysmal 
spasms of the flexor muscles, which later become continuous, re- 
sulting in opisthotonos or emprosthotonos. There is dimness of 
vision, while an increasing intensity of symptoms develops affections 
of other special senses, those of hearing and smell being either 
impaired or temporarily lost. Violent abdominal cramps also occur, 
together with painful dyspnea, death resulting from asphyxia or 
coma. 

The second (gangrenous) form is signalized by severity of local 
phenomena, profound dyscrasia, formication or cutaneous anesthe- 
sia, impairment of special senses, and numbness of the muscles or 
extremities, followed by sloughing or atrophy of the diseased parts 
and mummification, or dry or moist gangrene. 

Fatal results of chronic ergotism are usually traceable to the 
convulsions, although moist or dry gangrene may in certain cases 
produce death. 

A form of ergotism is described in Lombardy, Italy, occasioned 
by chronic poisoning with diseased or fermented maize, and affecting 
principally the cerebrospinal and digestive systems. It causes an 
acute erythema, which extends rapidly and is attended with much 
swelling, together with an extreme sensation of burning or itching. 
Pronounced nervous and general symptoms are present, and the 
malady not infrequently results in insanity or melancholia. Loco- 
motor-ataxia-like symptoms are also encountered when the vessels 
of the cord are involved. 

Treatment of Poisoning. — Symptoms of acute poisoning may be 
alleviated by hot baths and the administration of tannic acid and 
cardiac stimultants. For the treatment of chronic ergotism hygienic 
measures and symptomatic remedies are indicated. 



252 A TEXT-BOOK OF MATERIA MEDICA. 

Therapeutics. — Externally and Locally. — In the form of lozenges 
or diluted fluidextract the drug has been employed in acute 
pharyngitis. The hypodermic injections of ergotin are valuable 
in nasal hypertrophies, prolapsus of the rectum, hemorrhoids, enlarge- 
ment of the prostate gland, aneurism, varicocele, and varicose veins. 

Internally. — The most important medical use of ergot is to 
promote uterine contractions in labor. The preponderance of 
testimony among the most experienced obstetricians is in favor of 
its use only after the expulsion of the uterine contents. This is a 
rule, however, which cannot be invariably followed. While the 
employment of the drug is contraindicated in the first stage of 
labor, it may be safely employed during the second stage, when 
there is uterine inertia, provided all the parts be in a normal condi- 
tion and there exists no mechanical impediment to the rapid delivery 
of the child. Ergot is of service also when the placenta is retained 
owing to inefficient and feeble uterine contractions. 

No drug possesses so energetic and prompt an action as ergot 
in postpartum and uterine hemorrhage. It is an exceedingly effica- 
cious remedy also in subinvolution and in uterine fibroids and polypi. 

This remedy is also extremely useful in the treatment of plethoric 
amenorrhea, congestive dysmenorrhea, menorrJiagia, chronic metritis, 
etc. 

Dilatation of the cardiac cavities without valvular lesion is 
much improved by the administration of ergot ; the remedy has 
also been employed with considerable success in chronic diarrhea 
and dysentery. 

Incontinence of urine — depending either upon enlarged prostate, 
irritability, or a paretic or paralytic condition of the bladder — is 
greatly relieved by this remedy. The atonic form of spermatorrhea 
is palliated or cured by ergot. 

The drug is of value also in cerebral hyperemia and consequent 
mania, as well as in cerebrospinal meningitis, congestion of the spine, 
myelitis, and congestive headaches. 

Ergot has been highly recommended, notably by Dr. J. M. Da 
Costa, in diabetes insipidus, and by such authorities as Heltzmann 
and D'Enslow in prurigo, erythema, urticaria, and acne rosacea. 

Owing to the peculiar action of ergot upon unstriped muscular 
fiber it is a valuable drug in various forms of hemorrhage. 

Finally, this remedy has met with some success in the treatment 
of leukorrhea, galactorrhea, hypostatic congestion of the lungs, whoop- 
ing cough, the different varieties of purpura, colliquative sweats, 
splenic enlargements, and exophthalmic goiter. In the hands of 
many practitioners ergot is of great value in the treatment of alco- 
holism and morphinism. 

Contraindications. — During the first stage of labor and in cere- 
bral or spinal anemia. 

Administration. — For its action upon the uterus a valuable 
fluidextract is the best preparation as an internal remedy; for 
hypodermic use the aqueous extract (ergotin) or some of the non- 



DRUGS ACTING AS VASOCONSTRICTORS. 253 

alcoholic fluid preparations manufactured by certain reliable phar- 
macists for this particular purpose, should be employed. Ergotin 
may be incorporated in suppositories when for any reason it is 
desirable to administer the drug per rectum. 



Gossypii Cortex— Gossypii Corticis— Cotton Root 
Bark. U. S. B. 

Origin. — The dried bark of the root of Gossypium herbaceum L. and of other 
species of the genus, indigenous in the tropical and subtropical regions of Asia and 
Africa. The plant has been cultivated in the United States and other countries from a 
very early period, many characteristic varieties having been produced. 

Description and Properties.— It occurs in thin, flexible bands or quilled 
pieces, the outer surface brownish-yellow, with slight longitudinal ridges or meshes, 
small, black circular dots, or short, transverse lines, and dull, brownish-orange patches, 
from the abrasion of the thin cork ; inner surface whitish, of a silky luster, finely 
striate ; bast-fibers long, tough, and separable into papery layers ; inodorous ; taste 
very slightly acrid and faintly astringent. 

It contains a fixed oil, a small quantity of tannin, sugar, and starch, a yellow resin, 
and, in the fresh bark, a pale-yellow chromogene, soluble in alcohol, which on exposure 
to air becomes red and resinous. 

Dose. — 15-60 grains (1.04-4.0 Gm. ) [30 grains (2 Gm.), U. S. P.]. 

Antagonists and Incompatibles. — The same as for ergot. 

Synergists. — Ergot and its synergists. 

Physiological Action. — Resembling ergot somewhat, but in- 
ferior in certainty of action. 

Therapeutics. — Cotton-root bark is employed only for its action 
upon the uterus. An exception may possibly be in its use in the 
treatment of subinvolution and tumors of the uterus, in which cases 
it is less efficient than ergot. The drug is very unreliable, many 
pharmacologists claiming that it has no action on the uterus what- 
ever. 

Contraindications. — The same as for ergot. 

Administration. — The fluidextract only should be employed. 



Glandulae Suprarenales Siccae— Glandularum Su- 
prarenalium Siccarum— Desiccated Suprarenal 
Glands. U. S. P. 

Definition. — The cleaned, dried, and powdered suprarenal glands of the sheep 
or ox, freed from fat. 

Description. — A light, yellowish, amorphous powder, having a slight character- 
istic odor; partially soluble in water. I part of the dried glands represents approxi- 
mately 6 parts of fresh glands. Aqueous extracts of the glands rapidly deteriorate on 
keeping and should, therefore, be freshly prepared. 

Dose. — Average dose : 4 grains (0.250 Gm. =250 milligrammes), U. S. P. 

Researches by Abel and Crawford first demonstrated the pres- 
ence of an active principle. This they extracted in an impure form 
and termed it epinephrine. Takamine, by a different process, also 
extracted the principle and applied the name adrenalin. 



254 A TEXT-BOOK OF MA TERIA MEDICA. 

In commerce the principle is sold under the names of adrenalin, 
suprarenin, suprarenalin, adnephrin, epinephrine, epirenan, hemisine, 
etc. Probably few of the bodies are pure. 

Epinephrine is a nitrogenous body. Its structure is not definitely 
known, but it is thought to resemble the pyrrhol derivatives, par- 
ticularly skatol. 

Epinephrine itself as first isolated by Abel and Crawford is so 
unstable that it has not been possible to give it a satisfactory de- 
scription. Its salts, sulphates, and hydrochlorides are more satis- 
factory. The sulphate is a hygroscopic, straw-colored residue, 
which tends to crystallize on standing over sulphuric acid. Ag- 
glomerated groups of small crystals form on the edge of the 
receptacle, and the entire residue takes on a semicrystalline appear- 
ance. Adre7ialin is a more stable compound. 

Physiological Action. — With aqueous solutions of fresh speci- 
mens of the dried gland or with solutions of the salts this drug has 
a marked action on mucous membranes. A few drops of the solu- 
tion act as a rapid and strong astringent, whitening the mucous 
membrane by stimulating the contractile muscles of the blood- 
vessels. This action is local, and is manifest in the mucous mem- 
branes of the conjunctivae, nares, pharynx, membrana tympani, 
vagina, urethra, and rectum. The parts to which it is applied are 
rendered practically bloodless. This action persists for from fifteen 
minutes to half an hour following a single application. Partial 
anesthesia may occur. Repeated applications do not seem to cause 
paralysis of the blood-vessel, but often following the application 
an extreme secondary dilatation may occur. 

When administered by the mouth, some of the systemic effects 
of the drug may be developed, but it is by subcutaneous injection 
or intravenous infusion that the systemic effects are brought out. 
In general, these resemble those produced by the glycosides of 
the digitalis group. The heart action is rendered more forcible by 
direct muscular stimulation ; the rate is decreased by stimulation 
of the vagus centers ; and there is a very rapid and extreme rise 
in the blood-pressure, due to at least three elements — the strength- 
ening of the heart's contractions, marked general direct contraction 
of the muscular fibers, and a stimulation of the vasomotor centers. 

It has been observed that the pulmonary and cerebral vessels, and 
to a slight extent the vessels of the muscles, are less influenced 
than are the other vessels of the body. The retinal vessels have 
been observed to be dilated. The vessels of the abdominal organs 
are most influenced. 

The most potent factor in this constriction of blood-vessels is 
probably the direct irritant action of the drug on smooth muscle 
fibers, for throughout the body this tissue is decidedly stimulated. 
The pupil dilates, the intestines are stimulated to greater peristaltic 
activity, and the uterus contracts. 

In fact it has been demonstrated that as weak a solution as I : 
20,000,000 of adrenalin in water will cause the uterus of a gravid 



DRUGS ACTING AS VASOCONSTRICTORS. 255 

rabbit to contract with great vigor. 1 Adrenalin may cause abortion 
in rabbits if injected into the body of the uterus. 

The secretions, particularly of the saliva, tears, and bile, are 
stimulated, and adrenalin, by injection or by painting on the pan- 
creas, exerts a distinct action on the pancreatic function, causing 
glycosuria (Herter). The cause of adrenalin glycosuria is not yet 
positively known. 

It cannot be said that Sajou's contentions regarding the oxidi- 
zing functions of the suprarenal glands rest as yet on any substantial 
foundation. The hypotheses are fascinating and may be in part con- 
firmed, but thus far are not warranted by the known facts. 

Therapy. — This is still in its infancy. 

The suprarenal extract should be freshly prepared, its active 
principle being weakened by heat and preservation. It is the most 
powerful astringent known, a single drop of a 1 per cent, solution 
instilled into the eye resulting in a whitening of the conjunctiva 
and lids in from two seconds to forty minutes. It is useful in all 
forms of inflammation of the eye, whether traumatic, infectious, or 
proceeding from constitutional diseases, such as rheumatism, 
syphilis, or tuberculosis. The pupil is not contracted by it, and 
tolerance is not established by its use. It possesses neither anti- 
septic nor anesthetic properties, the rapid cures attending its em- 
ployment being entirely due to its blood-constricting influence. 

In suppurative otitis and dry catarrh the extract is often valuable 
in relieving congestion. By it tinnitus is permanently relieved. It 
lessens the congestion of turbinated bodies immediately, often 
benefiting catarrhal affections when cocaine and other astringents 
fail. It reduces the congestion of an inflamed eye sufficiently to 
permit cocaine anesthesia. It has been found efficacious in reliev- 
ing various strictures, as of the nasal duct, the urethra, and the 
esophagus. 

Velich found that the extract occasions local anemia when ap- 
plied to the skin, not only where there is a lesion, but also where 
the cuticle is unbroken. It has been used to whiten an eczema- 
tous patch and to prevent vesiculation. Dr. Douglas Stanley found 
that in one case of pernicious anemia the freshly prepared aqueous 
extract produced a marked increase in the number of red corpus- 
cles. It is valuable in Addison's disease (Osier), and is a tonic to 
the heart-muscles (Oliver and Schafer), " the tension being enor- 
mously increased by intravenous injections," though its action is 
less marked in subcutaneous use, and is uncertain when adminis- 
tered per os. It is much more rapid and distinct in its vessel-con- 
structing action than either digitalis or ergot, but also very evanes- 
cent. 

Its field of usefulness as a local astringent has not yet been fully 
explored. In nasal operations it renders the field of operation 
bloodless, and there is no reason why it cannot be used, when 

1 Kurdinowsky, " On Isolated Uterus of Pregnant Rabbits," Arch. f. Gyn., lxxiii., 
No. 2. 



256 A TEXT-BOOK OF MATERIA MEDICA. 

rendered aseptic, in abdominal or brain surgery, especially where 
continous oozing is a bar to good technic. 

The field for its systemic use will probably widen. It is a pow- 
erful heart tonic, and is particularly to be recommended in poison- 
ing by those drugs that cause vasomotor paralysis, notably chloro- 
form and chloral, and in threatened heart failure its use is to be 
commended. Addison's disease, confessedly related to the supra- 
renal gland in some obscure manner, may in time be benefited by 
its use, but as yet no markedly encouraging progress has been 
made in this direction. 

It has been of service in some cases of gastric hemorrhage, and 
may be tried in typhoid, but it is doubtful whether its secondary 
action may not prove harmful in this connection. 

XANTHINE DERIVATIVES. 
Caffeina— Caffeinae— Caffeine. 77. S. P. 

Origin. — A feebly basic substance [C 5 H(CH 3 ) 3 N 4 2 -f H 2 0], obtained from the 
dried leaves of Thea Sinensis (tea) L., or from the dried seeds of Coffea Arabica 
(coffee) L., and found also in other plants. 

It may also be prepared synthetically from theobromine by the introduction of a 
third methyl group. 

Description and Properties. — Fleecy masses of long, flexible, white crystals, 
having a silky luster, without odor and of a bitter taste ; permanent in the air ; soluble 
in 80 parts of water and 33 parts of alcohol. 

Dose. — 2-5 grains (0.12-0.3 Gm.) [1 grain (0.065 Gm.), U. S. P.]. 

Official Preparations. 

Caffeina Citrata — Caffeinae Citratae — Caffeine Citrate. — Description and Prop- 
erties. — A white powder, odorless, having a purely acid taste and an acid reaction. 
1 part of citrated caffeine forms a clear, syrupy solution with about 3 parts of water. 

Dose. — 2-5 grains (0.12-0.3 Gm. ) [2 grains (0.125 Gm.), U. S. P.]. 

Caffeina Citrata Effervescens — Caffeinae Citratae Effervescentis — Efferves- 
cent Citrated Caffeine. — Dose, 1-4 drachms (4.0-16.0 Gm.) [60 grains (4 Gm.), 
U. S. P.]. 

Physiological Action. — Externally and Locally. — Caffeine pos- 
sesses no very important local action, though freshly roasted coffee 
is slightly analgesic and deodorant — a property due to the empy- 
reumatic oils developed by roasting rather than to the caffeine 
which it contains. 

Internally. — Digestive System,— In moderate amounts caffeine, 
like tea and coffee, stimulates the appetite, improving the digestion, 
and relieving the sense of plenitude in the stomach. All of them 
increase peristalsis and (particularly coffee) act as mild laxatives 
and slightly stimulate the secretion of bile. 

Immoderate and continued dosage of caffeine or the excessive 
use of tea and coffee profoundly disturbs the digestive function, 
resulting in gastric catarrh, indigestion, hepatic congestion, consti- 
pation, and hemorrhoids. Tea, by reason of the high percentage 
of tannin contained, frequently causes constipation. 

Nervous System. — The drug is a decided cerebral excitant, stim- 



XANTHINE DERIVA TIVES. 257 

ulating the mental function, occasioning wakefulness, and under 
large doses producing hallucinations and delirium. 

Caffeine renders the reasoning and imaginative powers more 
acute, enabling the person to perform increased and prolonged 
mental work. Rarely, the ability to take in ideas is increased, and 
there is a heightened power of association of ideas. 

On the medulla caffeine is a stimulant. There is a rise in blood- 
pressure from vasoconstrictor action, quickening of breathing. 
The spinal cord reflexes are also rendered more responsive. 

Circulatory System. — Medicinal doses of caffeine strengthen and 
quicken the heart's action. The rapidity of the heart's action is 
increased, shortening the diastolic period, the drug in this respect 
differing from digitalis ; at the same time the arterial pressure is 
elevated. 

The precise modus opera?idi of caffeine in its action upon the 
circulatory system is still a disputed question, some investigators 
claiming that its whole and only influence proceeds from a direct 
stimulation of the heart-muscle, while others consider its action to 
be upon the nervous system. In a sense both are true. There is 
direct muscle stimulation and vagus inhibition. In some instances 
the heart is rapid by a preponderance of the one, in other cases, 
slowed by the greater action of the second. Blood-pressure 
increase is due to both central and peripheral causes. 

Respiration is both quickened and strengthened. It is one of the 
most reliable and least toxic of the direct respiratory stimulants. 

The moderate use of tea or coffee increases muscular endur- 
ance; large doses, on the other hand, occasion muscular trem- 
bling and marked weakness. Excessive doses lessen the activity 
of the spinal reflex centers. 

Caffeine and all of the xanthines are marked diuretics. They 
cause an increase in the fluids both by reason of increased filtering 
by heightened tension in the glomeruli, and they are also direct 
kidney epithelium stimulants. At times caffeine diminishes urinary 
secretion by a strong vasomotor action. Theobromine (mono- 
methyl xanthine) is a better diuretic. Both the liquid and solid 
parts are increased. 

Temperature. — Under large doses of the drug the temperature 
is slightly elevated, the result of combined increase of heat-pro- 
duction and heat-dissipation. Toxic doses first raise, and then 
depress, temperature. 

Eye. — Strong solutions of caffeine applied to the cornea act as 
a mild mydriatic and anesthetic. Hutchinson records a case of 
amblyopia produced by the drug. 

Absorption and Elimination. — Caffeine is freely absorbed, and is 
readily broken down in the body — first, into lower methylated xan- 
thines and then into urea. 

Ordinarily caffeine lessens tissue-waste ; the elimination of urea, 
however, is not uniform, being in some cases increased and in others 
diminished. 

17 



258 A TEXT-BOOK OF MATERIA MEDICA. 

Untoward Action. — Caffeine occasionally causes marked cere- 
bral congestion, insomnia, and embarrassment of respiration, while 
the untoward effects of an immoderate use of coffee are described 
by Guilliot (Nat. Disp., p. 363) as follows : 

" The skin is pale or dusky, the expression is dull, and the 
features have the look of premature old age, and sometimes are 
slightly swollen. The flesh wastes, the eyes have a glassy look, 
the pupils are dilated, the lips and tongue are tremulous ; the 
appetite is lost ; there is insomnia or else disturbed sleep ; dyspep- 
sia accompanies constipation or diarrhea ; neuralgia affects the 
stomach and other parts ; headache and vertigo are common, and 
spasms or general convulsions may occur." According to the 
same writer, " habitual excess of coffee induces in men sexual 
apathy and impotence, and in women leucorrhea. Sometimes it 
produces pruritus ani aut vulva." 

Poisoning. — A case has been reported by Liell where 18 grains 
(1.16 Gm.) of citrated caffeine taken by a women were in an hour 
and a half accompanied by the following symptoms : 

"Delirium, semi-consciousness, absence of headache, pulse 55 
and irregular, cold extremities and general clammy perspiration, 
normal temperature (?), anesthesia, slight paresis of hands, feet, 
and tongue, and a reeling gait. Convulsions followed of a teta- 
noid character ; the pupils were normal, the vision dim ; some 
vomiting took place ; there was abdominal colic, but no opening 
of the bowels ; and urination was frequent and copious." 

Treatment of Poisoning. — This should include the use of emetics 
and eliminants, together with diffusible stimulants and the applica- 
tion of external heat. 

Therapeutics. — Externally and Locally. — Burning coffee in a 
room deodorizes the air. 

Internally. — The chief value of caffeine is as a diuretic and 
cardiac stimulant, being peculiarly useful in cases of senile cardi- 
opathies associated with nephritis, in which, from degeneration of 
the heart-muscle, digitalis is not well tolerated.- 

In some instances the primary effect of caffeine is to increase 
the pulse-rate ; usually, however, if the remedy be adapted to the 
case, there is a secondary slowing of the heart's action. The drug 
is considered by some physicians to be superior to digitalis as a 
cardiac stimulant in valvular disease accompanied by fatty heart. 
It is an efficient remedy to counteract the cardiac depression in low 
fevers, and is a comparatively safe drug in myocarditis. 

It is a remarkably efficacious remedy in cardiac and renal 
dropsy and to remove pleuritic effusion, etc. 

Caffeine cannot displace digitalis as a heart tonic, but as diuretics 
the xanthin derivatives, caffeine and theobromine, are excellent. 
Theobromine is the better diuretic of the two. They both act as 
stimulants to the kidney epithelium, and contrasted with the saline 
diuretics, which increase the elimination of inorganic salts, the 



XANTHINE DERI VA TI VES. 259 

xanthine derivatives aid in the elimination of nitrogenous substances, 
notably urea and uric acid. 

Its action upon the digestive system renders caffeine of great 
value as a stomachic tonic. Migraine, due either to gastric catarrh 
or nervousness, frequently yields to this drug. 

Its value in the treatment of headaches may be enhanced by 
administering it together with antipyrine or sodium bromide. 

Choleraic diarrhea, the result of nervous depression, is often 
markedly benefited by citrated caffeine. It has also been used 
with some success in the diarrhea of phthisis. 

Sodiobenzoate of caffeine in doses of 5 to io grains (0.32- 
0.64 Gm.) is considered by Misrachi to be superior to ergot in 
postpartum hemorrhage. Caffeine possesses a considerable repu- 
tation as a remedy for asthma. Caffeine is invaluable in the treat- 
ment of shock, and in all poisoning associated with low blood- 
pressures and respiratory depression. 

It is a matter of frequent observation that strong coffee cer- 
tainly modifies the effects of alcoholic intoxication. Hiccough is 
often relieved by coffee. 

Caffeine or strong coffee has unquestionably proved valuable 
in the reduction of strangulated hernias after taxis has failed. 

The medical uses of caffeine would be incomplete without 
mention of its extreme value in opium-poisoning. Here a salt of 
caffeine may be used hypodermically or a strong infusion of coffee 
given by the mouth or rectum. 

Contraindications. — Ordinarily, caffeine is contraindicated in 
acute inflammations, particularly of the kidney. 

Administration. — The alkaloid may be given by the stomach, 
but when hypodermic medication is desired caffeine is unavailable, 
a fresh salt for hypodermic use being properly employed, made by 
combining caffeine with salicylic acid, cinnamic acid, or sodium 
benzoate. The latter salt — sodio-benzoate of caffeine — is probably 
the most eligible and contains 45 per cent, of caffeine. 

The citrated caffeine should be given in pills, capsules, or 
tablets ; the effervescent citrate, in water. 

A valerianate of caffeine is prepared which has been employed 
with success, it is asserted, in hysterical vomiting and whooping 
cough in doses of from J to 2 grains (0.03-0.12 Gm.). 

Strong coffee serves as a most excellent substitute for the alka- 
loid, and may be given by the mouth or as an enema. 

Meat Extracts. — These contain high percentages of xanthin or 
purin bases, creatin, creatinin, etc., in addition to mineral salts. It 
was at first assumed, by the manufacturer at least, that these beef 
extracts represented the concentrated essence of beef, and as such 
they were valuable food-products. Such, however, is not the case, 
and this class of bodies is best classed with the xanthin stimulants. 
Their action is on the heart and blood-vessels and they are active 
diuretics. They are not foods in any sense. 



260 A TEXT-BOOK OF MATERIA MEDICA. 

DRUGS ACTING CHIEFLY TO INHIBIT CARDIAC 
ACTIVITY AND TO CAUSE VASODILATATION* 

Aconitum— Aconiti— Aconite. U. S. I*. 

Origin. — The dried tuberous root of Aconitum Napellus L., collected in autumn, 
and yielding when assayed not less than 0.5 per cent, of aconitine, a plant about 40 
inches (1 M.) high, met with throughout the greater portion of Asia and Europe, 
mostly in mountainous regions. 

Other species of Aconitum contain aconitine. Thus the Himalayan plant Aconitum 
ferox contains it, and a closely related alkaloid, pseticaconitine, while the Aconitum 
Japonicum contains japaconitine. Aconitine is chemically an acetyl benaconine. 

Description and Properties. — From f to f inch (10-20 Mm.) thick at the 
crown, and from 2 to 3 inches (50-75 Mm.) long, with scars or fragments of radicals; 
dark brown externally, whitish internally ; with a rather thick bark, the central axis 
about seven-rayed ; without odor, taste at first sweetish, soon becoming acrid, and pro- 
ducing a sensation of tingling and numbness lasting for some time. It contains an 
acrid alkaloid, aconitine. 

Dose.— £-2 grains (0.03-0. 1 2 Gm.) [1 grain (0.65 Gm.) U. S. P.] 

Official Preparations. 

Fluidextractum Aconiti - Fluidextracti Aconiti — Fluidextract of Aconite. 
— Dose, yq-2 minims (6.006-0.12 Cc.) [1 minim (0.05 Cc), U. S. P.]. 

Tinctura Aconiti — Tincturae Aconiti — Tincture of Aconite. — 10 per cent — 
Dose, 1— 15 minims (0.015-1 Cc. ) [10 minims (0.6 Cc), U. S. P.]. 

Aconitina— Aconitinae— Aconitine. 

Definition. — An alkaloid obtained from Aconite. 

Description and Properties. — Colorless or white rhombic tables or prisms, 
odorless, permanent in the air, and producing in extremely diluted solutions a character- 
istic tingling sensation when brought in contact with the mucous membrane of the 
tongue or lips. The alkaloid itself should never be tasted, and its solution only when 
largely diluted, and then with the utmost caution. The chemical structure of aconi- 
tine is analogous to that of atropine and cocaine. 

Very slightly soluble in water (1 : 3200), much more so in alcohol (1 : 22). 

Aconitine was formerly in the U. S. Pharmacopoeia, but was dropped in 1880, 
owing to the variable composition of the article then on the market. At present there 
are on the market, in addition to the crystalline aconitine, an amorphous aconitine and 
an eclectic "aconitin." The greatest caution should be observed not to confuse these 
preparations, as they differ considerably in composition. 

Aconitine is the most powerful drug in the Pharmacopoeia ; death is reported to 
have resulted from 0.5 milligramme (y\j g ra i n )- 

Dose.— Average dose: 0.00015 Gm. = 0.15 milligramme ( r ^ grain) (U. S. P.). 

Oleatum Aconitinae— Oleati Aconitinae— Oleate of Aconite.— A 2 per cent, 
solution of Aconitine in Oleic Acid. For external use. (N. F. ). 

Physiological Action. — Externally and Locally. — Applied to 
mucous membranes or to the skin for any length of time, aconite 
first stimulates and then depresses the ends of the sensory nerves, 
producing respectively tingling, numbness, and local anesthesia. 

Internally. — Digestive System. — Except when given in very di- 
lute solutions, aconite produces tingling and numbness of the lips 
and mouth, with increased secretion from the salivary glands. 
Large doses cause great irritation, together with a sense of con- 
striction in the fauces. Anesthesia to taste is also produced. 



DRUGS TO INHIBIT CARDIAC ACTIVITY. 261 

Under normal conditions of the stomach aconite may act upon 
that organ as a sedative, augmenting its secretions. Large doses 
may occasion pain, nausea, and vomiting. 

Nervous System. — Moderate or even large doses have little or 
no effect on the cerebral centers. The main action of aconite in 
the nervous system is on the medulla. Here there is stimulation 
followed by depression. Excessive doses of aconite cause a slight 
stimulation of the sensory nerve-endings, finally followed by 
depression, the muscles passing into a state of paralysis, probably 
occasioned by direct action upon the muscle-tissue. 

Circulatory System. — Aconite causes a marked slowing of the 
heart's action, due to stimulation of the vagus center in the me- 
dulla. Following the slowing of the heart, due to vagus action, 
aconite has a direct action on the heart-muscle, increasing its irri- 
tability, causing it to become very rapid and weak, eventually occa- 
sioning delirium cordis through overstimulation. Death may 
occur from cardiac paralysis, the heart being arrested in diastole. 
The arterioles are at first contracted, owing to stimulation of the 
vasomotor center in the medulla ; but a marked diminution in the 
force of the ventricular systole brings about a great decrease of 
blood-pressure. In poisoning there is vessel dilatation and great 
loss of blood-pressure. 

Respiratory System. — The respiration is slowed by moderate 
doses ; under large doses it is rendered both shallow and slow. 
The breathing is retarded, because the peripheral endings of the 
vagi distributed to the lungs are depressed. Under large doses 
there is depression of the respiratory center, paralysis of which 
is occasioned by lethal amounts. 

Absorption a?id Elimination. — Aconite is rapidly absorbed, but 
its channels of elimination are not definitely known, although it is 
probably excreted by the kidneys, and to some extent by the skin, 
the drug acting as a mild diaphoretic. 

Temperature. — Aconite is alleged to be a decided antipyretic, the 
reduction of temperature being due to various causes : (1) The slow- 
ing of the circulation, diminishing the metabolism ; (2) the peripheral 
action of aconite, causing dilatation of the cutaneous blood-vessels ; 
(3) the depressing action of the drug upon all muscle-tissue. 

Eye. — Toxic amounts of the drug have produced mydriasis, 
misty vision, and diplopia. 

Untoward Action. — Besides the symptoms described under 
" Poisoning," there have been observed pustular and erythematous 
eruptions, vertigo, and dimness of vision. 

Poisoning. — The first effect of toxic doses is to cause marked 
tingling of the tongue and lips, which sensation soon extends to 
the fingers and may even affect the entire cutaneous surface. There 
is extreme muscular weakness, particularly noticeable in the lower 
extremities. Salivation, excessive cold clammy perspiration, nausea, 
vomiting, diarrhea, and pain in the stomach occur. The pulse, at 
first slow and weak (down to 40), soon becomes rapid and almost im- 



262 A TEXT-BOOK OF MATERIA MEDICA. 

perceptible. The respirations are quite feeble and shallow, being 
at times reduced to 10-12 to the minute, and there may be marked 
dyspnea. 

The countenance is anxious and the skin pallid, cold, and cov- 
ered with sweat, with great reduction of temperature. These symp- 
toms are accompanied by dimness of vision, the pupils usually being 
widely dilated. Rarely there are present epileptiform convulsions. 

Death may be postponed for some time, or it may rapidly follow 
a lethal dose. The minimum lethal dose of aconitine for adults is 

JL 

50 



grain (0.00-3 Gm.). 



Treatment of Poisoning. — The patient should be placed in a 
horizontal position, better with the feet raised slighly. The 
stomach should be thoroughly evacuated ; bodily heat should be 
maintained by external warmth ; diffusible stimulants, such as ether, 
alcohol, and spirits of ammonia should be given. Caffeine is useful, 
but artificial respiration is of the greatest service. 

Therapeutics. — Externally and Locally. — Whether locally ap- 
plied or given internally aconite is an excellent remedy in neuralgias, 
particularly in tic douloureux. The tincture, aconite liniment, 
or an ointment of aconitine may be applied to the course of the 
affected nerve. The tincture of aconite frequently proves bene- 
ficial in herpes zoster, chilblain, pruritus, etc., and its extended appli- 
cation has even been recommended to allay the pain of chronic 
rheumatism. 

Internally. — Aconite is an exceedingly efficacious remedy in 
many febrile diseases, particularly the sthenic fevers of children and 
those fevers resulting from inflammation, such as tonsillitis, laryn- 
gitis, pharyngitis, quinsy, etc. The drug seems to exert a pecu- 
liarly beneficial influence on mucous membranes, all acute inflam- 
matory conditions of the throat, bronchial tubes, or intestinal canal 
— characterized by fever, a small, wiry pulse, and rapid cardiac 
action — being greatly improved by the remedy. 

As previously indicated, aconite is one of the most efficient 
sedatives in the irritative fevers of children. It is equally valuable 
in the first stage of pneumonia and in pleurisy, and is an invaluable 
adjunct to opium in the treatment of peritonitis. 

Pericarditis is often favorably influenced by this drug, while it is 
also of great service in allaying nervous palpitation of the heart or 
that due to excessive cardiac hypertrophy. 

The injection into the rectum of 8 or 10 minims (0.5-0.6 Cc.) of 
the tincture of aconite, while perhaps producing a slight pro- 
lapsus of the rectum, quickly affects an irritable stricture of the 
urethra, so that a catheter may be passed with little difficulty, 
although the operation may have been previously found impos- 
sible. 

Probably there is no better combination to "break up a cold" 
than aconite and Dover's powder, the tincture of aconite, given 
at frequent intervals for a few hours, being followed, preferably at 
bedtime, with 8 or 10 grains (0.5-0.6 Gm.) of Dover's powder. 



DRUGS TO INHIBIT CARDIAC ACTIVITY. 263 

Aconite has been favorably recommended in the acute stages 
of cerebrospinal meningitis and as a cardiac sedative in aneurism. 

Contraindications. — Aconite is always contraindicated in sub- 
acute or chronic conditions, or when the heart's action is weak. It 
is also intolerable in catarrhal conditions of the stomach. 

Administration. — A good, reliable tincture is the best prepara- 
tion for internal use. Moreover, better results are obtained by 
giving the drug in fraction of minim doses — from y 1 ^- to \ minim 
(0.006-0.03 Cc.) in a teaspoonful of water every fifteen minutes — 
than by larger dosage. The most desirable influence of the drug 
appears to be realized by this method. 

Veratrum— Veratri— Veratrum. XT. S. P. 

(American Hellebore.) 

Origin. — The dried rhizome and roots of Veratrum viride Solander, a plant 
growing in swampy places and damp thickets in Canada, and in the United States as 
fa.r south as Georgia. The plant closely resembles V. album of Europe, and is also 
allied to a species found in Eastern Siberia. 

Description and Properties. — Rhizome upright, obconical, simple or di- 
vided, from 2 to 3 inches (50-75 Mm.) long; externally blackish-gray, internally 
grayish-white, showing numerous short, irregular wood-bundles. Many shrivelled, 
light yellowish-brown roots issue from all parts of the rhizome. 

The drug is inodorous, but strongly sternutatory when powdered, the taste bitterish 
and very acrid. 

Veratrum viride contains the following alkaloids : veratrinejervine, pseudojervine, 
rubijervine, and cevadine. The veratrine is in small amounts only. The closely related 
Asagraq officinalis or Sabadilla contains veratrine in larger amounts ; it also contains 
a related alkaloid protoveratrine. 

Dose. — 5—5 grains (0.01-0.3 Gm.) [2 grains (0.125 Gm.), U. S. P.]. 

Official Preparations. 

Fluidextractum Veratri — Fluidextractum Veratri — Fluidextract of Vera- 
trum. — Dose, |~5 minims (0.01-0.3 Cc.) [ij minim (0.1 Cc), U. S. P.]. 

Tinctura Veratri— Tincturae Veratri — Tincture of Veratrum (10 per cent.). 
— Dose, 1— 15 minims (0.06-1 Cc.) [15 minims (1 Cc), U. S. P.]. 

Allied Drugs. 

Veratrum Album — Veratri Albi — White or European Hellebore. 

Sebadilla— Sebadillae— Cevadilla. 

The seeds of this plant yield the following official alkaloid, known as Veratrine : 

Veratrina— Veratrinae— Veratrine. 77. S. JP. 

Definition. — A mixture of alkaloids obtained from the seed of Asagraea offici- 
nalis (Charts and Schlech.) Lundl. 

Description and Properties. — A white or grayish-white, amorphous or 
semicrystalline powder ; odorless, but causing intense irritation and sneezing when- 
ever even a minute quantity reaches the mucous membrane ; of an acrid taste, and leav- 
ing a sensation of tingling and numbness on the tongue ; permanent in the air ; very 
slightly soluble in hot or cold water, soluble in 3 parts of alcohol. 

Dose. — £q-\ grain (0.0016-0. 016 Gm.) [J^ grain (0.002 Gm.), U. S. P.]. 

Official Preparations. 

Oleatum Veratrinae — Oleati Veratrinae — Oleate of Veratrine (2 per cent.). 
For external use. 

Unguentum Veratrinae — Unguenti Veratrinae— Veratrine Ointment (4 per 

cent.). For external use. 



264 A TEXT-BOOK OF MATERIA MEDICA. 

Antagonists, Incompatibles, and Synergists are the same as 
for Aconite. 

Physiological Action. — Externally and Locally. — Veratrum is 
more of an irritant than aconite, exciting some inflammation of 
the skin when applied locally, and when in contact with the nasal 
mucous membrane producing violent sneezing. 

Internally. — Its effects are in every respect analogous to those 
of aconite, with the following exceptions, in the several systems : 

Digestive System. — Veratrum is more apt to occasion nausea 
and vomiting. 

Nervous System. — It causes, as does aconite, analgesia, and in 
large doses also paralyzes the muscles in an unknown manner. 
Under moderate doses there is extreme muscular weakness. Vera- 
trine causes this loss of muscular power, while pseudoveratrine 
does not. 

Circulatory System. — The drug is a more powerful depressant 
to the circulation, small doses, while not materially affecting the 
pulse-rate, greatly reducing its force ; large doses rendering the 
pulse very weak, almost indistinguishable, and very rapid. 

Respiratory System. — Veratrum depresses the respiration less 
than aconite. 

Absorption and Elimination. — The drug is absorbed with great 
facility, and is eliminated chiefly by the bowels. It possesses much 
feebler diuretic and diaphoretic properties than aconite. 

Temperature. — In medicinal doses it is not so powerful an anti- 
pyretic as aconite. 

Untoward Action. — Veratrum occasionally produces an erythem- 
atous or pustular eruption. 

Poisoning. — Except that the drug may cause less anesthesia, 
the symptoms of poisoning are almost identical with those occa- 
sioned by aconite. 

Treatment of Poiso?iing. — The same as prescribed for aconite. 

Therapeutics. — Externally and Locally. — Veratrum viride is 
seldom, if ever, used locally. Veratrine, though in rare cases 
given internally, is well-nigh restricted to external or local applica- 
tion. 

The oleate or ointment of veratrine when applied over the 
affected nerve is exceedingly efficacious in neuralgia, particularly 
in tic douloureux and orbital neuralgia. In the latter affection great 
care should be taken in administration, lest some portion of the 
drug enter the eye, in which case violent and persistent conjuncti- 
vitis would ensue. 

Internally. — Veratrum viride may be employed for the same 
conditions for which aconite is recommended, although it is doubt- 
ful whether it possesses any advantages over the latter drug ; in- 
deed, by many competent physicians it is considered inferior to, 
and more dangerous than, aconite. Moreover, the nausea and 
vomiting which in many patients are likely to follow the ingestion 
of this drug render its use objectionable. A large number of 



DRUGS TO INHIBIT CARDIAC ACTIVITY. 265 

physicians claim to have found it of value in the treatment of 
puerperal eclampsia. Here it should be given in doses sufficient to 
cause nausea or even vomiting. 

Contraindications. — The same as for aconite. 

Administration. — The tincture of veratrum viride only should 
be given, beginning with small doses, as recommended for aconite, 
and cautiously increasing the amount. Veratrine may be applied 
in the form of an ointment, oleate, or in solution together with 
alcohol and glycerin. 

Phytolacca— Phytolaccae— Phytolacca. V. S. I*. 

(Poke- root.) 

Definition. — The dried root of Phytolacca decandra L. 

Description and Properties. — Large, conical, branched, and fleshy ; mostly 
in transverse or longitudinal slices, wrinkled, grayish, hard ; fracture fibrous, the wood- 
bundles in several distinct concentric circles ; inodorous ; taste sweetish and acrid. It 
contains resin, gum, fixed oil, tannin, starch, sugar, and a glycosid. Phytolaccotoxin 
is an alkaloid related to picrotoxin, which is found in a Japanese speciesof Phytolacca. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Official Preparations. 

Fluidextractum Phytolacca — Fluidextracti Phytolaccae — Fluidextract of 
Phytolacca. — Dose, 5-30 minims (0.3-2.0 Cc.) [1J-15 minims (o.l-i Cc.) as altera- 
tive or emetic respectively. (U. S. P.). 

Physiological Action. — Externally arid Locally. — The powdered 
root is extremely irritating to mucous membranes, in certain sub- 
jects occasioning an erythematous eruption and excoriations. 

Internally. — Digestive System. — Phytolacca possesses emetoca- 
thartic properties. It occasions much nausea, with great depression, 
persisting for some time before vomiting occurs. The drug aug- 
ments the secretion of bile and acts as a laxative. 

Nervous System. — Poke-root is a powerful motor depressant, 
acting as a direct paralyzant to the spinal cord and medulla, 
although the muscles and motor nerves are unaffected. 

Circulatory System. — Like aconite, it reduces the force and fre- 
quency of the heart's action and lowers arterial tension. 

Respiratory System. — Phytolacca is a respiratory depressant, 
rendering the breathing slow and shallow. Toxic doses produce 
death by paralysis of the respiratory center, preceded by tetanic 
convulsions. 

Absorption arid Elimination. — The drug is readily absorbed, and 
is eliminated chiefly by the kidneys. 

Temperature. — Medicinal doses have no effect on temperature. 

Poisoning. — The symptoms of poisoning are quite similar to those 
produced by veratrum, though the nausea and vomiting are post- 
poned longer after the ingestion of phytolacca. 

Treatment of Poisoning. — The same as recommended under 
Aconite and Veratrum. 

Therapeutics. — Externally and Locally. — Preparations of phyto- 



266 A TEXT-BOOK OF MATERIA MEDICA. 

lacca have been successfully used to allay inflammation, as in cases 
of follicular pharyngitis, tonsillitis, mastitis, ulcers , buboes, burns, ab- 
scesses. The drug is also useful in chronic eczema, sycosis, favus, 
etc. The fluidextract may be applied, or the powdered root 
incorporated in ointment either signally or associated with other 
medicinal agents. 

Internally. — The drug has proved of doubtful service in chronic 
rheumatism , its alterative properties rendering it also of some ser- 
vice in the treatment of scrofula, syphilis, and chronic diseases of the 
skin. 

It has been recommended in obesity, possessing undoubted 
efficacy in this respect. It is claimed that the proprietary prepa- 
ration known as "Anti-fat" is a resinoid preparation of the berries. 

Contraindications. — The same as for veratrum viride. 

Administration. — No special directions are necessary. The 
powder, tincture, or fluidextract may be given internally ; for topical 
use an ointment may be prepared. 

Pulsatilla— Pulsatillae— Pulsatilla. (Non-official.) 

Origin. — The herb of Anemone Pulsatilla and Anemone pratensis L., collected 
soon after flowering. 

Description and Properties. — Leaves radical, petiolate, silky-villous, twice 
or thrice deeply three-parted or pinnately cleft, with linear, acute lobes, appearing after 
the large purple flowers ; inodorous, very acrid. It contains a peculiar, acrid, crystal- 
lizable principle known as anemonin. Other constituents not as yet isolated may also 
be present. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Physiological Action. — Externally and Locally. — Pulsatilla is 
a decided irritant to the skin, the bruised plant when rubbed upon 
it even producing vesication. In the mouth it produces a sensation 
of burning, succeeded by numbness. 

Internally. — The action of the drug is similar to that of aconite, 
though pulsatilla possesses greater emetic properties. 

Therapeutics. — The drug may be employed for the same pur- 
poses as aconite, though as a cardiac sedative it is less efficient. It 
has been recommended as a useful emmenagogue. 

Arnica— Arnicae— Arnica. U. S. JP. 

Origin. — The dried flower-heads of Arnica montana L., a plant indigenous in 
the mountainous regions of Europe and Northern Asia, and also found in the north- 
western part of America. 

Description and Properties.— Heads about 1 to 2 inches (25-50 Mm.) in 
diameter, depressed-roundish, consisting of a scaly involucre in two rows, and a small, 
nearly flat, hairy receptacle, bearing about sixteen yellow, strap-shaped, ten-nerved 
ray-florets and numerous yellow, five-toothed, tubular disk-florets, with slender, spindle- 
shaped akenes crowned by a hairy pappus. Odor feeble and aromatic ; taste bitter 
and acrid. 

Arnica flowers contain a glycosid (?), arnicin, a volatile oil, caproic and caprylic 
acids, resins, tannin, etc. 

Dose. — 5-30 grains (0.3-2.0 Gm.) [15 grains (i Gm.), U. S. P.]. 



DRUGS TO INHIBIT CARDIAC ACTIVITY. 267 

Official Preparation. 

Tincture Arnicae — Tincturae Arnicae — Tincture of Arnica (20 percent.). — 
Dose, 10-30 minims (0.6-2.0 Cc). Chiefly, however, used externally as a vulnerary. 

The root of Arnica montana and all its preparations official in the Pharmacopoeia 
of 1890, have been dropped from the Pharmacopoeia of 1 900. 

Physiological Action. — Externally and Locally. — The local 
action of both the root and flowers is irritant, that of the latter 
being the more powerful. Occasionally tincture of arnica flowers 
produces marked inflammation of the skin, resembling erysipelas. 

Internally. — The internal effects of arnica are as yet imperfectly 
understood, it being difficult to assign the drug to its proper group. 

Digestive System. — Small doses slightly stimulate the digestive 
apparatus. Large amounts produce nausea, vomiting, and diarrhea 
of a choleraic character. 

Nervous System. — Large amounts cause headache, with great 
depression of the nerve-centers. Toxic amounts occasion motor 
and sensory paralysis, coma, at times convulsions, collapse, and 
death. 

Circulatory System. — Small doses stimulate the heart and in- 
crease arterial pressure ; full or large doses retard the pulse and 
depress the circulation. 

Respiratory System. — The respiration is slowed, although under 
small doses there may be temporary acceleration. 

Absorption and Elimination. — The active principle of arnica dif- 
fuses readily into the blood, the drug being eliminated chiefly by 
the kidneys, though the skin shares in the excretory process. 

Temperature. — Large doses cause a reduction of temperature. 

Untoward Action. — The topical application of arnica may cause 
in susceptible persons violent cutaneous inflammation and the pro- 
duction of pustules, or even distinct bullae, attended with marked 
constitutional symptoms. When taken internally the drug occa- 
sions a sensation of burning in the mouth and throat, violent pain 
in the stomach, tenesmus, and choleraic diarrhea, intense headache, 
and dizziness. 

Poisoning. — In addition to the above-named symptoms there are 
great cardiac depression, decided muscular weakness, slow and 
shallow respiration, paralysis of the nervous system, and death 
resulting from collapse. 

Treatment of Poisoning. — The treatment should be much the 
same as that prescribed under Aconite. Atropine is probably the 
best physiological antidote. 

Therapeutics. — Exter?ially and Locally. — Arnica enjoys a wide 
reputation as a remedy for the relief of bruises, sprains, and external 
inflammations generally. It is highly probable that its efficiency is 
due in part to a slight counterirritant effect, and to the alcohol con- 
tained in the mixtures. It has been recommended also as a topical 
application in myalgic rheumatism. The local application of the 
tincture causes the rapid disappearance of ecchymoses. Equal 



268 A TEXT-BOOK OF MATERIA MEDICA. 

parts of tincture of arnica and glycerin, diluted with water, have 
been recommended as a stimulant in inflammation of the mucous 
membrane of the mouth. 

Internally arnica is not a very popular remedy. 

Contraindications. — Externally when there exists any acute 
skin disease ; internally in cases of inflammation of the gastroin- 
testinal tract, fatty or valvular disease of the heart, and in all 
asthmatic conditions. 

Administration. — The tincture of arnica is the form generally 
preferred for external and internal use. In applying any prepara- 
tion externally the susceptibility to the irritating properties of the 
drug peculiar to certain persons should be remembered. 

VASODILATORS. 

One set of the circulatory drugs has the primary property of 
dilating the blood-vessels and of reducing the blood-pressure. 
This action is in large part due to a depressing action they exert on 
unstriped muscular fiber, particularly on the walls of the blood- 
vessels. These drugs are practically the exact opposites to the 
group adrenalin and ergot. They are all nitrites, in which the NO 
ion is the active part of the molecule. The most important of 
these are amyl nitrite, nitroglycerin, sodium and potassium nitrite, 
erythrol tetranitrite and mannitol hexanitrite. 

In addition to their action on the blood-vessels the nitrites 
affect the blood. They cause the formation of methemoglobin and 
thus limit oxidation in the tissues. 

Amylis Nitris— Amylis Nitritis— Amyl Nitrite. U.S.I*. 

Origin. — A liquid containing about 80 per cent, of amyl (principally iso-amyl) 
nitrite. Obtained by the action of nitric acid upon amylic alcohol. 

Description and Properties. — A clear yellow or pale-yellow liquid, of a 
peculiar, ethereal, fruity odor and a pungent, aromatic taste. Almost insoluble in 
water; miscible in all proportions with alcohol or ether. In alcoholic solution it grad- 
ually decomposes, with formation of ethyl nitrite and amylic alcohol. It should be 
kept in small, dark-colored, glass-stoppered bottles, in a cool and dark place, remote 
from lights and fire. 

Dose. — £-1 minim (0.03-0.06 Cc.) internally; for inhalation 1-5 minims (0.06- 
°-3 Cc.) [3 minims (0.2 Cc), U. S. P.]. 

Physiological Action. — Externally and Locally. — Its action is 
that of a mild irritant when applied to the skin. 

Internally. — The following actions apply to ingestion or inhala- 
tion of the drug. 

Digestive System. — No important action has been observed. 

Nervous System. — Among the effects are cerebral oppression, 
flushing of the head and face, vertigo, headache, and confusion of 
ideas, with diminished reflex excitability, muscular weakness, and- 
unsteadiness of gait, both the voluntary and involuntary muscles 
being relaxed. These actions are due to the depressing influence 
of the drug upon the motor areas of the brain and spinal cord. 



VASODILATORS. 269 

Circulatory System. — Almost immediately after inhalation of 
amyl nitrite there is a marked flushing of the skin, first perceptible 
in the face, doubtless occasioned by dilatation of the capillaries. 
The heart's action is increased and somewhat weakened, and the 
pulse is soft and compressible. The blood-pressure falls very 
markedly, the condition being caused by a paralyzing action upon 
the muscle-fibers found in the walls of the small arterioles, causing 
marked dilatation. The same cause accounts for the change in the 
action of the heart, due to diminution of peripheral resistance. 
Amyl nitrite has little central action. 

The inhalation of large amounts renders the heart very weak, 
toxic doses arresting that organ in diastole. 

Respiratojy System. — Small doses quicken the respiration by 
lowering arterial pressure and possibly by moderate stimulation of 
the center, due to accumulation of carbon dioxide. Immoderate 
or toxic amounts render the breathing slow and labored from 
depression of the respiratory center and arrest of the oxygenating 
function of the blood. 

Absorption and Elimination. — Amyl nitrite is rapidly absorbed, 
being eliminated chiefly by the kidneys, increasing the amount of 
urine, uric acid, and urea excreted. Sugar may frequently be de- 
tected in the urine, probably resulting from the action of the drug in 
dilating the hepatic vessels and increasing the circulation in the liver. 

Blood. — Amyl nitrite, as all the nitrites, causes fixation meth- 
hemoglobin to take the place of oxyhemoglobin. Nitric-oxide- 
hemoglobin compounds are also formed. The blood becomes dark 
chocolate in. color and asphyxiation may result, though rarely. 

Temperature. — Bodily heat is reduced both in health and in 
fever, due to dilatation of the peripheral blood-vessels and a reduc- 
tion of the oxygen-carrying power of the red blood-corpuscles. 

Eye. — There is marked dilatation of the retinal vessels and 
hyperemia of the papilla, producing chromatopsia of the parti- 
colored variety and hallucinations of vision. These effects are 
usually transitory, and disappear with the elimination of the drug. 

Uterus. — The uterine muscle is relaxed. 

Untoward Action. — In addition to the symptoms described under 
" Poisoning," there have been noted gastric disturbance, nausea and 
vomiting, dryness of the mouth and trembling of the lips, irritation 
of the throat, defective vision, and subjective sensations of color, 
usually yellow vision. 

Poisoning. — The toxic effects of amyl nitrite include an exceed- 
ingly rapid and weak heart, final retardation of the pulse, cyanosis 
of the face, slow and shallow respiration, cold extremities, subnor- 
mal temperature, great muscular weakness, abolished reflexes, 
vertigo, intense headache, and disordered vision. Death results 
from cardiac or respiratory failure. 3.0 Gm. swallowed by mistake 
by a sixty-year-old man has produced alarming symptoms lasting 
several hours. The characteristic banana-like odor is valuable in 
diagnosis. Fusel oil is not distinguishable from it by odor alone. 



2 JO A TEXT-BOOK OF MATERIA MEDIC A. 

Treatment of Poisoning. — Strychnine and digitalis are required 
to sustain the heart ; ergotin or atropine may be administered sub- 
cutaneously, together with cold applications to the head, diffusible 
stimulants, and artificial respiration if necessary. Adrenalin is 
valuable. 

Sodii Nitris— Sodii N it ritis— Sodium Nitrite. TJ. &. J\ 

Origin. — It should contain not less than 90 per cent, of pure sodium nitrite. 
Obtained by heating sodium nitrate with lead, the oxygen from the nitrate being ab- 
stracted by the lead oxide formed. 

Description and Properties. — White, opaque, fused masses, usually in the 
form of pencils, or colorless, transparent, hexagonal crystals ; odorless, and of a mild, 
saline taste. When exposed to the air the salt deliquesces and is gradually oxidized to 
sodium nitrate. Soluble in about 1.5 parts of water; slightly soluble in alcohol. It 
should be kept in well-stoppered bottles. 

Dose. — 2-5 grains (0.12-0.3 Gm. ). 

Other Nitrites. 

Erythrol tetranitrate and mannitol hexanitrite are organic nitrates that have 
similar action. This action is more prolonged, and is therefore to be recommended in 
chronic conditions. Dose, y z grain (0.5 Gm. ). 

The comparison of the activity of these various nitrites is graphically represented 
in the following chart taken from Bradbury. 



5 10 20 


30 


JfO 


sp 


J Hour , 






, 


Z Hours 


^T — '^^--~~ *~ 















c== 


rr=^"-'- 




.-- 


s'" 


----- 


::----- 


— 




^S 7 






£" 














a 



















Fig. 1. — Diagram to illustrate the intensity and duration of the action of the members 
of the nitrite series. The extent of the fall of pressure is measured along the vertical, the 
duration along the horizontal, line: a, Amyl nitrite, ethyl nitrite, etc.; b, nitroglycerin; 
c, sodium nitrite ; d, erythrol tetranitrate. The greatest reduction occurs in a, but it 
passes off for the most 'part in five minutes and entirely in twenty. Nitroglycerin acts 
more rapidly than the last two, and its effects continue almost as long as those of sodium 
nitrite. Erythrol tetranitrate only exerts its full effect after the action of the others has 
passed off (Bradbury). 

Spiritus Glycerylis Nitratis— Spiritus Glycerylis Ni- 
tratis— Spirit of Glyceryl Trinitrate. V. S. P. 

(Spirit of Nitroglycerin.) 

Definition. — An alcoholic solution containing I per cent, by weight of glyceryl 
trinitrate. 

Origin. — Nitroglycerin is obtained by gradually adding dehydrated glycerin to a 
mixture of nitric and strong sulphuric acid, the nitroglycerin formed being washed with 
water and dilute soda solution to remove all acid. 

Description and Properties.— Nitroglycerin occurs as a clear colorless 
liquid possessing the odor and taste of alcohol. It should be tasted and handled with 
great caution, since it is apt to produce violent headache, whether ingested or applied 
to the skin. It explodes with great force, and should be kept in a cool place, remote 
from lights or fire. 

Dose.— 1-3 minims (0.06-0.18 Cc.) of the spirit [1 minim (0.05 Cc), U. S. P.], 

The action of nitroglycerin is very similar to that of amyl nitrite, 
although it is less prompt, while more persistent. Nitroglycerin 



VASODILA TORS. 271 

produces a frontal headache of much greater intensity than that 
caused by amyl nitrite. This is also true of sodium nitrite, though 
the headache it occasions is less severe than that resulting from 
nitroglycerin. 

Nitroglycerin is preferable to amyl nitrite for internal admin- 
istration. 

Therapeutics. — Externally and Locally. — The nitrites are not 
used for external purposes. 

Internally. — The property of amyl nitrite in suddenly lower- 
ing arterial pressure and dilating the arterioles renders it of inesti- 
mable value as a relief for the terrible precordial pain in angina 
pectoris. 

Epileptic seizures may often be aborted by the instant inhalation 
of amyl nitrite upon the first indication of the aura epileptica. The 
drug has also been successfully employed for the relief of asthma, 
particularly the uremic form, as well as for cardiac dyspnea and 
puerperal eclampsia. 

Like many other motor depressants, it has been used in the 
treatment of tetanus and strychnine-poisoning. It has proved an 
efficient preventive for the chill occurring in virulent malarial fever, 
and has served as a valuable antidote in poisoning from chloroform. 

The drug is indicated in all conditions of high arterial tension, 
as in chronic nephritis, etc. It is also beneficial in congestive dys- 
menorrhea. 

The sodium nitrite is used for the same purposes as the amyl 
nitrite, though superior to it for internal administration, as in cases 
of abnormally high arterial tension. 

Nitroglycerin is specially adapted for the treatment of cardio- 
pathies occurring after middle life. It is useful in chronic nephritis 
with high arterial tension, and, associated with digitalis, is recom- 
mended in certain cases of pneumonia. The tendency to increase 
of peripheral resistance in the vessels after adult life is attained 
renders possible the favorable administration of doses of nitrogly- 
cerin intolerable in early life. 

The drug is often of marked benefit in the arrhythmia of slightly 
enlarged and degenerated hearts with arteriosclerosis. It is also 
of considerable value in relieving the pseudo-anginas which are 
frequently a feature of vascular disease. It should be given in 
doses of -jirQ to yj-g- grain (0.00032-0.0006 Gm.) twice or four 
times daily. 

Osier recommends the prolonged administration of nitroglycerin 
in locomotor ataxia, affirming that it lessens the frequency of the 
crises and relieves the neuralgic pains. 

The drug is of use in sciatica, and frequently relieves obstinate 
hiccough. It has been recommended for the same diseases for 
which amyl nitrite is used. 



272 A TEXT-BOOK OF MATERIA MEDICA. 

PREPARATIONS OF AMMONIUM* 

Aqua Ammoniae Fortior— Aquae Ammoniae Fortioris 
—Stronger Ammonia Water. U. S. P. 

Origin. — An aqueous solution of ammonia (NH 3 = 16.93), containing 28 per 
cent, by weight of gaseous ammonia. 

Description and Properties. — A colorless, transparent liquid, having an 
excessively pungent odor and a very acrid and alkaline reaction. It should be kept in 
strong, glass- stoppered bottles. 

Dose. — 3-6 minims (p.18-0.3 Cc). 

Official Preparation. 

Spiritus Ammoniae — Spiritus Ammonias — Spirit of Ammonia. — Origin. — 
An alcoholic solution of ammonia, containing 10 per cent, by weight of the gas. 

Description and Properties. — A colorless liquid, having a strong odor of ammonia 
and a specific gravity of about 0.808 at 25 C. (77 F. ). It should be kept in glass- 
stoppered bottles, in a cool place. 

Dose, 10-60 minims (0.6-3.7 Cc. ) [15 minims (1 Cc), U. S. P.]. 

Aqua Ammoniae— Aquae Ammoniae— Ammonia 
Water. U. S. P. 

Origin. — An aqueous solution of ammonia, containing 10 per cent, by weight of 
gaseous ammonia. 

Description and Properties. — A colorless, transparent liquid, having a pun- 
gent odor, an acrid, alkaline taste, and a strongly alkaline reaction. It should be kept 
in glass-stoppered bottles, in a cool place. 

Dose. — 10-20 minims (0.6-1.2 Cc.) well diluted [15 minims (1 Cc), U. S. P.] 

Official Preparations. 

Linimentum Ammonias — Linimenti Ammoniae — Ammonia Liniment (Am- 
monia Water, 350; Alcohol, 50 ; Cotton-seed Oil, 570; Oleic Acid, 30). — For exter- 
nal use. 

Spiritus Ammoniae Aromaticus — Spiritus Ammoniae Aromatici. See Am- 
monium Ca?'bo?iate. 

Ammonii Carbonas-Ammonii Carbonatis— 
Ammonium Carbonate. U. S. P. 

Definition.— It should contain not less than 97 per cent, of a mixture of acid 
ammonium carbonate [CO(OH)ONH 4 ] and ammonium carbamate [CO(NH 2 )ONH 4 ], 
and should yield not less than 31.58 per cent, of ammonia gas. 

Origin. — Prepared bv subjecting to sublimation and resublimation a mixture of 
ammonium sulphate or chloride and calcium carbonate. 

Description and Properties.— White, hard, translucent, striated masses, 
having a strongly ammoniacal odor without empyreuma, and a sharp, saline taste. On 
exposure to air the salt loses both ammonia and carbonic acid, becoming opaque, and 
is finallv converted into friable, porous lumps or a white powder. Slowly but com- 
pletely soluble in about 5 parts of water; decomposed by hot water, with the elimina- 
tion of carbonic acid and ammonia. 

Ammonium carbonate should be kept in well-stoppered bottles, in a cool place. 

Dose. — 2-15 grains (0.12-I.0 Gm.) [4 grains (0.25 Gm. ), U. S. P.]. 

Official Preparation. 

Spiritus Ammoniae Aromaticus— Spiritus Ammoniae Aromatici— Aromatic 
Spirit of Ammonia (Ammonium Carbonate, 34; Ammonia Water, 90; Oil of Nut- 



VASODILA TORS. 273 

meg, I; Oil of Lemon, 10; Alcohol, 700; Oil of Lavender Flowers, I; Water to 
make 1000). 

Description and Properties. — A nearly colorless liquid when freshly prepared, but 
gradually acquiring a somewhat darker tint. It has a pungent, ammoniacal odor and 
taste. It should be kept in glass-stoppered bottles, in a cool place. 

Dose.— %-2 fluidrams (1.8-7.3 Cc -) [3° minims (2 Cc), U. S. P.]. 

Antagonists and Incompatibles. — The cardiac sedatives are 
antagonistic. The incompatibles are the vegetable and mineral 
acids, the earthy salts, lime water, and solutions of acidulous salts. 

Synergists. — Cardiac and diffusible stimulants, antispasmodics, 
and capsicum internally. The local action of ammonium prepara- 
tions is enhanced by cantharides and counterirritants. 

Physiological Action. — Externally and Locally. — When solu- 
tions of ammonia are applied to the skin or mucous membranes 
they act as irritants, rubefacients, or vesicants according to the 
strength of the solution and the freedom or confinement of the 
vapor. 

When inhaled the vapor occasions great irritation of the respi- 
ratory passages, together with a sense of suffocation and spasmodic 
closure of the glottis. There are also produced marked irritation 
of the conjunctivae, lachrymation, and a watery secretion from the 
nose. 

Internally. — Digestive System. — Small doses act like alkalies 
upon the gastro-intestinal tract, augmenting the flow of gastric 
juice when given before meals and neutralizing it when given after 
meals. 

Excessive doses occasion violent and destructive inflammation 
of the mouth, esophagus, and stomach, possibly resulting in stric- 
ture of the esophagus and stenosis of the pyloric orifice. 

Nervous System. — Other than their action upon the sensory 
nerves when locally applied, these preparations affect the nervous 
system only in stimulating the motor centers of the spinal cord, 
excessive doses causing convulsions similar to strychnine. 

Circulatory System. — These preparations, whether ingested or 
injected into the system, cause a temporary fall of arterial pressure, 
quickly followed by a decided increase and acceleration of the pulse, 
owing to nervous stimulation of the heart. Their precise action 
upon the blood is not known, though they certainly lessen the 
oxygen-carrying power of the red corpuscles and diminish the 
tendency to coagulation of the blood. 

Respiratory System. — They stimulate the respiratory center, 
greatly increasing the number of respirations. 

Absorption a7id Elimination. — The preparations of ammonium 
are rapidly absorbed, being oxidized in the system and eliminated 
chiefly by the kidneys, increasing the acidity of the urine and aug- 
menting its amount, as well as increasing the proportion of nitric 
acid, uric acid, and urea excreted. The continued use of ammo- 
nium preparations therefore promotes tissue-waste. 

Temperature is unaffected by medicinal amounts. 

18 



274 A TEXT-BOOK OF MATERIA MEDICA. 

Poisoning. — In toxic doses these preparations are powerful cor- 
rosive poisons, exciting violent inflammation of the gastro-intestinal 
tract, labored respiration, great cardiac depression, muscular weak- 
ness, and possibly convulsions. 

Treatment of Poisoning. — Similar to that of poisoning by the 
corrosive alkalies — evacuation of the stomach, the internal admin- 
istration of vinegar or other vegetable acids, followed by oil and 
demulcent drinks, opium being indicated for the relief of pain. 

Therapeutics. — Aqua ammonia is a valuable ingredient of 
" hair tonics " in premature alopecia. The ammonia liniment is a 
favorite remedy for chilblains. 

The aromatic spirit of ammonia is of value in many diseases 
of the scalp, such as pityriasis, etc., and, when well diluted with 
water, has been recommended in acute pharyngitis. The ammonium 
carbonate possesses an action similar to that of salicylic acid in 
its property of dissolving epidermic scales, rendering it of value 
in preparing the skin for the subsequent local treatment of 
psoriasis. 

As a counterirritant ammonia water — or, preferably, the am- 
monium liniment — is efficient in chrojiic rheumatism and joint- 
affections. 

Ammonia water relieves the irritation caused by bites of insects ; 
its vapor inhaled acts as a rapid restorative in cases of fainting. 

Internally. — The ammonium preparations here mentioned are 
serviceable in lessening excessive acidity of the stomach. The 
aromatic spirit of ammonia is frequently beneficial in allaying 
the distress of nervous Jicadaclie, and is also an efficient remedy to 
counteract the effects of an immoderate use of alcoholic stimulants, 
in many cases having proved valuable in the treatment of delirium 
tremens. 

The most important uses of these preparations are, perhaps, as 
powerful diffusible stimulants to the circulatory, respiratory, and 
spinal systems. They are of undoubted value in sudden cardiac 
failure arising from any cause, such as poisoning from chloroform, 
noxious gases, hydrocyanic acid, etc. Taken internally or by intra- 
venous injection, they counteract the poisonous effects resulting 
from the bites of venomous reptiles. 

The carbonate is an excellent stimulant to sustain the heart 
and respiration during the course of pneumonia, eruptive and con- 
tinned fevers, etc. In all dynamic conditions of the heart this 
preparation should be given in small doses, frequently repeated. 

The carbonate is also a valuable stimulant expectorant in chronic 
bronchitis and bronchopneumonia. 

The preparations of ammonia have been recommended in 
threatened thrombosis. The condition being established, however, 
it should be noted that the method of treatment by intravenous 
injection, advocated by some authorities, is at best a very dubious 
procedure. 

Contraindications. — Acute gastritis and conditions of excessive 



VASODILATORS. 275 

acidity of the urine. Conditions of anemia and great emaciation 
would contraindicate the prolonged use of these preparations. 

Administration. — The liquid preparations should always be 
well diluted, and the carbonate should invariably be given in solu- 
tion. The fluidextract of glycyrrhiza disguises the taste very 
well. 

Owing to the rapid elimination of these drugs, the dosage 
should be frequently repeated. 



DRUGS ACTING LOCALLY ON MICRO-ORGANISMS 
(ANTISEPTICS). 



Many substances that act upon the protoplasm of living cells, 
either physically or chemically exert either a restrictive action on 
micro-organisms or are capable, according to the grade of concen- 
tration, of killing the micro-organisms themselves or their spores. 
These substances may be roughly classed as antiseptics. Germi- 
cides is a broader term. Bactericides are agents capable of killing 
bacteria or their spores ; zoocides are similar agents capable of 
killing minute animal parasites in the body of man or lower 
animals. 

Great differences are found in the action of these substances 
whether the micro-organisms are spore-bearing or not. Thus, 
many bacteria are killed by a .1 per cent, solution of corrosive sub- 
limate in a few minutes ; while it requires an hour or even longer 
to kill the spores of other bacteria by this same bactericide. The 
spores of the anthrax bacillus can resist the action of 5 per cent, 
solutions of carbolic acid for several days. Analogous facts are 
known with reference to the animal parasites of malaria. Thus, 
quinine kills the free forms of the malarial parasites, while the 
encysted spore-bearing forms are killed with considerable diffi- 
culty. 

General rules with reference to the germicidal action of various 
agents then are very difficult of application. Each organism is a 
law unto itself and should be so considered. 

The germicides may be readily grouped into a few classes, and 
a chemical classification seems the most satisfactory. The groups 
that will be here considered are : 

1. Metalloids : ozone, oxygen, hydrogen peroxide, other perox- 
ides, and oxidizing agents. 

These act largely as active oxidizers. 

2. Metals and metallic salts. These act largely as protoplasm 
poisons, usually coagulating the albumin of the cell-body. Mer- 
cury, zinc, tin, copper, lead, aluminum, silver, etc. 

3. Acids and alkalies. 

4. Halogens and their combinations. 

5. Bodies of the aromatic and fatty series, alcohols, aldehydes, 
anilines, phenols, volatile oils, etc. 

276 



OXIDIZING GERMICIDES. 211 

L OXIDIZING GERMICIDES* 

Oxygen itself is not directly applicable as a germicide. In 
nature it undoubtedly plays an important part in general disin- 
fection. 

Ozone, O s , as a gas has a feeble germicidal action. Wyssoko- 
witsch has shown that in a percentage of 20-30 miligrams to the 
100 cubic meters it has a restraining action on the development of 
many bacteria. Ozone, according to the researches of Ransome 
and Fullerton, has no particular action on the vitality of the tuber- 
cle bacillus. 

Ozone developed in water by electrical means has some bac- 
tericidal action, but it is highly doubtful if it is a practical method 
for water disinfection, the results of Schrceder and Proskauer 1 
notwithstanding. 

Among the most useful of the oxidizing agents are the perox- 
ides of hydrogen, and a number of recently introduced organic 
peroxides under the trade names of acetozone, alphazone, etc. 

Aqua Hydrogenii Dioxidi— Aquae Hydrogrenii Diox- 
idi— Solution of Hydrogen Dioxide. U. S. JP. 

Origin. — A slightly acid, aqueous solution of hydrogen dioxide, which should 
contain, when freshly prepared, about 3 per cent, by weight of absolute hydrogen di- 
oxide, corresponding to about 10 volumes of available oxygen. 

Description and Properties. — A colorless liquid, without odor, slightly 
acidulous to the taste, and producing a peculiar sensation and a soapy froth in the 
mouth; liable to deteriorate with age or by exposure to heat or protracted agitation. 

Dose. — 1-4 fluidrams (3.7-15.0 Cc), well diluted with water [1 fiuidram (4 Cc), 
U. S. P.]. 

Physiological Action. — Externally and Locally. — Applied to 
the skin it decomposes, but without much effect save in strong 
solution, when it irritates. 

Applied to mucous membranes hydrogen peroxide is decom- 
posed and oxygen is given off in large quantities. The oxygen 
given off is nascent and oxidizes surrounding substances very ener- 
getically. Applied to wounds or open surfaces the oxygen is given 
off in very large quantities. 

In the stomach large quantities are also evolved, causing disten- 
tion of the stomach in some instances. It is usually broken down 
completely before reaching the intestines. 

Injected hypodermically oxygen is liberated, and if a blood- 
vessel is entered emboli of oxygen may form and it may thus cause 
death. Intravenous injection causes gas emboli and death. 

The catalytic activity of the various organs after death varies 
considerably. 

Therapeutics. — Externally and Locally. — Hydrogen dioxide is 
extensively employed to cleanse diseased surfaces, such as ulcers, 
buboes, fistulous tracts, etc. It has been highly recommended as an 

1 Zeitschrift f. Hygiene, vol. xli. 



278 A TEXT-BOOK OF MATERIA MEDICA. 

antiseptic in abdominal surgery. As an antiseptic wash in empyema, 
cy stitis , joint-cavities , venereal sores, puerperal septic endometritis, etc., 
hydrogen dioxide is an exceedingly valuable agent. 

Hydrogen dioxide appears to be an efficient injection in gonor- 
rhea, and is much used as an antiseptic in many diseases of the 
eye, ear, nose and throat. It has been highly recommended as an 
application for diphtheritic membrane , although when frequently 
applied to the throat it causes an unpleasant sensation of dryness. 
It is highly valuable in tonsillitis. It is to be recommended for 
loosening up necrotic tissue wherever applicable. 

Hydrogen dioxide serves a useful purpose in disinfecting drink- 
ing-water when suspected of pollution, 1 part sufficing for 1000 
parts of water, in which amount the taste or other potable quali- 
ties of the water are in no way impaired. 

Internally it has no important actions yet carefully studied. It 
may prove of some value in gastro-intestinal affections, and its use 
in the rectum, where the gas may be absorbed, is said to be of value 
by some clinicians. 

Administration. — For external and local use the drug may be 
gargled, sprayed, or applied with a syringe or a swab, either in full 
strength or diluted with water. Whether for external or internal 
use, the solution should be freshly prepared; when given internally 
it should be taken from a porcelain or china, not a metal, cup or 
spoon. 

ORGANIC PEROXIDES. 

Organic peroxides have recently been manufactured. By re- 
placing one of the hydrogens in H 2 2 , HOOH, by acetyl or ben- 
zoyl, CH3CO— O— OH, C 6 H 5 CO— O— OH, acetyl peroxide and 
benzoyl peroxides are formed. Many others are possible, but as 
yet they are all comparatively unstable bodies. When two acetyl 
radicals are combined, CH 3 CO — O— O— COCH 3 , or acetyl and 
benzoyl, CH 3 CO— O— O— COC 6 H 5 , a more stable series are formed. 
Acetozone and alphazone are of this general composition. 

These organic peroxides have very powerful germicidal effects, 
and, moreover, as they split off their oxygen very slowly they have 
some important indications in gastro-intestinal affections that are 
not met by the more readily decomposable hydrogen peroxide. 

They are valuable in gastric and intestinal fermentations and 
putrefactions, and have given some very striking results in limiting 
the distention in typhoid fever. That they can influence the disease 
process as a whole is hardly conceivable, by reason of the wide dis- 
tribution of the typhoid bacillus, but these newer peracids have 
been useful in overcoming some of the distressing intestinal 
symptoms. 

Whether they are to prove of service in increasing intracellular 
oxidative processes is a question of the future. 

Both acetozone and ALPHAZONE are used in solutions. 

A PEROXIDE OF BISMUTH, Bi0 2 , has also been introduced of late 



OXIDIZING GERMICIDES. 279 

years. It is termed biogen commercially and it is claimed that it 
is valuable in increasing the oxidation functions of the body. It is 
used in doses of 5 to 10 grains. 

Calcium peroxide, gorite, is another of this general type. It 
is used as an intestinal disinfectant in 2- to 10-grain doses. 

The persulphates of sodium and potassium, Na 2 S 2 O s , persodines, 
are commercially obtainable and are under investigation. 

Potassii Permanganas- Potassii Permanganatis— 
Potassium Permanganate. U. S. 2*. 

Definition. — It should contain not less than 99 per cent, of pure potassium per- 
manganate. 

Origin. — Obtained by heating together caustic potash, potassium chlorate, and 
manganese dioxide. The potassium manganate formed is converted into the perman- 
ganate by boiling it in water. 

Description and Properties. — Slender, monoclinic prisms, of a dark-purple 
color, almost opaque by transmitted light, and of a blue, metallic luster by reflected 
light ; odorless, with at first a sweet and afterward a disagreeable and astringent taste ; 
permanent in the air ; soluble in 16 parts of water. In contact with alcohol it is de- 
composed. 

Potassium permanganate should be kept in glass-stoppered bottles, protected from 
light, and should not be brought in contact with organic or readily oxidizable sub- 
stances. 

Dose. — \-2 grains (0.03-0.12 Gm.), as a pill [1 grain (0.065 Gm.), U. S. P.]. 

Antagonists and Incompatibles. — Organic matter easily deox- 
idizes it, causing an explosion. 

Synergists. — Other antiseptics enhance its germicidal action. 

Physiological Action. — Potassium permanganate in contact 
with organic matter gives up a part of its oxygen. It loses its 
color thereby and is no longer active. Its action is very energetic 
but very superficial. 

Therapeutics. — Externally and Locally. — In concentrated solu- 
tions or in substance it is a mild escharotic. Its readiness to part 
with oxygen renders it of great value as a deodorant, and in dilute 
solutions, 1 to 5 grains (0.06 to 0.32 Gm.) to 1 ounce (30 Cc.) of 
water, it is a useful application to foul ulcers, cancer of the uterus, 
vagina, etc. A solution of this drug is employed for various pur- 
poses as an antiseptic, germicide, and deodorant, in the treatment 
of gonorrhea, leucorrhea, diphtheria, putrid sore throat, ozena, naso- 
pharyngeal catarrh, cancer of the tongue, and syphilitic ulcers. 

A weak solution of potassium permanganate is an efficient ap- 
plication in bromidrosis, and a 1 : 2000 or I : 5000 solution is recom- 
mended in purulent ophthalmia. Potassium permanganate should 
not be used as an antiseptic in the peritoneal cavity, on account of 
its irritating properties. It is employed extensively in surgical 
practice for washing the hands and utensils. 

Internally. — Like iron, potassium permanganate has been em- 
ployed in anemia, although far inferior to the former drug. Favor- 
able reports are given regarding its value in gastric fermentation 
and lithiasis. 



280 A TEXT-BOOK OF MA TERIA MEDICA. 

It has been recently advocated as an antidote to morphine- 
poisoning. Later investigations do not support the early claims. 
It has an oxidizing effect and undoubtedly destroys the free mor- 
phine substances that may remain in the stomach or be eliminated 
there. 

Administration. — For internal use potassium permanganate 
should always be given in pill form, kaolin being used as an 
excipient, lest an explosion occur. 

IL METALS AND THEIR SALTS, 

The metals and their salts as a class are treated elsewhere in 
this volume, but a few words may be said concerning their action 
as germicides. They act as such largely because of the property 
of precipitating or coagulating protoplasm. Some few of these 
coagula are soluble in an excess of the metal or its salts. In this 
case the action as a germicide may be penetrating, whereas, for the 
most part, the action of the metallic germicides is superficial. 

It has been pointed out that the germicidal power of any sub- 
stance varies within fairly wide limits, particularly with regard to 
the spore-bearing and non-spore-bearing forms. For practical pur- 
poses the table on page 281 shows the efficient metallic germicides, 
and their relative toxicities to certain forms of micro-organisms. 

IIL ACIDS, ALKALIES, SALTS, ETC* 

Many of the acids and alkalies are active antiseptics. In weak 
solutions hindering the organisms in their growth, in stronger solu- 
tions killing them by withdrawing water, by coagulation of proto- 
plasm, or by other physico-chemical interchange. 

For the acids, those that dissociate readily are more actively 
germicide, thus tri-chlor-acetic acid, by reason of its ready power 
of dissociation, is almost as efficient a germicide as the much more 
powerful nitric acid. Acetic and formic acids are relatively weak 
because of their diminished powers of dissociation. 

Sulphuric, nitric, acetic, boric, and arsenous acids are the acids 
more commonly employed, while sodium, potassium, and ammonium 
hydrates, the various soaps, etc., are the alkalies used. 

As these bodies for the greater part are considered in this work 
more in detail under the head of Caustics, etc., they are best con- 
sulted in those chapters. Only a few will be considered in this 
place. 

Acidum Sulphurosum— Acidi Sulphurosi— 
Sulphurous Acid. U. S. r. 

Origin. — A liquid composed of not less than 6 per cent, by weight of sulphur 
dioxide and about 94 per cent, of water. 

Description and Properties. — A colorless liquid, of the characteristic odor 
of burning sulphur, and of a very acrid, sulphurous taste. It should be kept in dark- 
OOlored, glass-stoppered bottler in a cool place, and protected from light. 

Dose. \-2 fluidrams | 1 >-; 39 Cc.) [30 minim> (2 Co.), U. S. P.]. 



ACIDS, ALKALIES, SALTS, ETC 



281 



DISINFECTING POWER OF COMMONLY USED ANTISEPTICS. 1 

St = Sternberg ; M = Miquel ; K = Kitasato. 

.Antiseptic : Pre- 
vents Perma- 
nently the 
putre faction 
of Bouillon 

Inoculated Germicidal 

with Sewer to Anthrax to Typhoid 
Bacteria. Spores. Bacilli. 

f : 1,000 few"] 

min. (Koch) I 

10,000, two J 
L hours (St) J 
I : 12,000 (M) : 4,000 



HgCl 2 . . 

AgN0 3 . 

FeS0 4 . . 

CuS0 4 . . 

ZnCl 2 . . 

A1 2 C1 6 . . 
AC 2 K 2 (S0 4 ) 

H 2 S0 4 . 



1 : 15,000 (M) 



0,000 two 

hours 

(Frankel) 



As 2 3 

CaO 

S0 2 . 
KMnO. 



Br 



90 (M) 

1 : no (M) 

I : 500 (M) 
I : 720 (M) 
I : 222 (M) 
I : 800 (St) 

1 : 250 (K) 
I : 143 (M) 
1 : 166 (M) 
I : 



not 



not 

not 
not 



I : positive 
1 : 285 (M) 

1 : 20,000 (M) 

I : 1,666 (M) 



a. ... 

Calx chlorata 1 

CHCI3 ... 1 

CHI3 ... 1 
Formaldehyd 
(absolute) 1 

C 2 H 5 OH . . 1 



1 : 4,000 (M) 



: positive 

: 5,000 
(checks de- 
velopment 
of typhoid) 
: 333 (M) 



: 100, ten days 
(Koch) 



not 

: 20, one day 
(Koch) 

: 125, 2 hours 
(St) 

: 50, twenty- 
four hours 
(Koch) 

: 100, 3 hrs. 
(Fisher) 

: 100, two hrs. 
(Boer) 
not 

not 



not 
: 100, two hrs. 
: 20, ten min. 
(Leitz) 



: 1,550, 24 

hours 

(Boer) 
: 330, 5 hours 

(K) t 

: 300, 5 hours 
(K) 



: 1,000, five 

hours (K) 

positive 



need moisture 



need moisture 



2,000, 2 hrs. 

(Boer) 
200, 1 hour 

(Kirchner) 



33, two days : 100, 2 hours : 1,000 aureus 
(Koch) (Bolton) (Slater and 

Rideal) 

1 The results of the observations of different experimenters are not com- 
parable, since the proteid content of the solutions is not uniform. 



282 A TEXT-BOOK OF MATERIA MEDICA. 

Physiological Action. — Externally a?id Locally. — Sulphurous 
acid is a powerful deoxidizing agent. It easily abstracts oxygen 
from organic bodies, the acid being a powerful disinfectant, anti- 
septic, deodorant, and parasiticide. 

Internally. — The disinfecting properties of sulphurous acid are 
less apparent when the drug is ingested than when it is used 
externally. 

Therapeutics. — Externally and Locally. — As an antiseptic, dis- 
infectant, and deodorant sulphurous acid may be employed in the 
treatment of various parasitic skin diseases, and a solution of sul- 
phurous acid affords an efficient application to the throat in pharyn- 
gitis, particularly the gangrenous form, diphtheria, etc. 

According to Dujardin-Beaumetz, Sollaud, and Balbaud, non- 
febrile pulmonary phthisis is often favorably influenced by the daily 
inhalation for a short time of sulphurous-acid vapor. This dis- 
agreeable, not to say dangerous, method of treatment has neither 
been generally adopted nor proved to be of established efficacy. 

The acid is a useful antiseptic to apply to recent wounds, and 
may be employed to disinfect the dejections of the sick. The fumes 
of sulphur are worthless as general disinfectants. They may be 
of service in killing mosquitoes, but dry fumes are practically inert 
so far as their action on bacteria is concerned. Burning sulphur as 
a means of disinfection is largely a fetish founded on ancient and 
superstitious ideas regarding infectious diseases. 

Internally. — Sulphurous acid is seldom used internally, though, 
owing to its powerful antifermentative properties, it has been em- 
ployed in so-called fermentative dyspepsia, intestinal fermentation, 
and urticaria. While it checks fermentation in the laboratory, its 
effect is less certain in the body ; nor can the internal administra- 
tion of the drug be regarded as satisfactory. 

Administration. — Sulphurous acid should be given well diluted 
with water. 

Sodii Sulphis— Sodii Sulphitis— Sodium Sulphite. 

U. S. P. 

Origin. — Prepared by saturating a solution of sodium carbonate or caustic soda 
with sulphur-dioxide gas. It should contain in the uneffloresced and air-dried condi- 
tion not less than 96 per cent, of pure sodium sulphite. 

Description and Properties. — Colorless, transparent, monoclinic prisms ; 
odorless, and having a cooling, saline, sulphurous taste. In the air the salt effloresces 
and is slowly oxidized to sulphate. Soluble in 2 parts of water ; sparingly soluble in 
alcohol. It should be kept in well-stoppered bottles, in a cool place. 

Dose. — 5-60 grains (0.3-4.0 Gm.) [15 grains (1 Gm.), U. S. P.]. 

Sodii Bisulphis— Sodii Bisulphitis— Sodium 
Bisulphite. U. 8. P. 

Origin. — Prepared from sodium carbonate or bicarbonate and sulphur dioxide. 
It should contain not less than 90 per cent, of pure sodium bisulphite. 

Description and Properties. — ( )paque, prismatic crystals, or a granular 
powder, exhaling an odor of sulphur dioxide, and having a disagreeable, sulphurous 



HALOGENS. 283 

taste. Exposed to the air, the salt loses sulphur dioxide and is gradually oxidized to 
sulphate. Soluble in 3.5 parts of water and in 70 parts of alcohol. The drug should 
.be kept in a cool pace, in small, well-stoppered bottles, filled as full as possible. 
Dose. — 5-30 grains (0.3-2.0 Gm.) [7 J grains (0.5 Gm.), U. S. P.]. 

Sodii Thiosulphas— Sodii Thiosulphalis— Sodium 
Thiosulphite. U. S. P. 

Origin. — Prepared by passing sulphurous anhydride into a solution of sodium 
carbonate with salts. It should contain not less than 98 per cent, of pure sodium thio- 
sulphate. 

Description and Properties. — Colorless, transparent, monoclinic prisms ; 
odorless, and of a cooling, afterward bitter, taste. Soluble in 0.35 part of water at 25 
C. ; insoluble in alcohol. It should be kept in well-stoppered bottles. 

Dose.— 5-20 grains (0.3-1.3 Gm.) [15 grains (1 Gm.), U. S. P.]. 

Physiological Action and Therapeutics of Sodium Sulphite, 
Bisulphite, and Thiosulphite. — These substances are feeble ger- 
micides and antiseptics, checking putrefaction and other forms of 
fermentation. It is supposed that they are decomposed in the 
stomach, liberating sulphurous anhydride ; on which assumption 
they have been given to arrest gastric fermentatio7i and as reme- 
dies in typhoid and yellow fevers, diphtheria, erysipelas, etc. The 
hypothesis, however, upon which they have been thus hopefully 
employed has not been confirmed by clinical experience. 

These drugs have nevertheless proved efficacious in the treat- 
ment of scabies, sycosis, impetigo, favus, etc. Atomized solutions 
of sodium hyposulphite inhaled are beneficial in ga?igrene of the 
lungs , fetid bronchitis , etc. 

Administration. — The foregoing preparations of sulphur may 
be given in solution or in this form applied topically. The sodium 
thiosulphite may be applied in the form of an ointment. 

IV. HALOGENS. 

The haloid compounds of fluorine, chlorine, bromine, and iodine 
all possess specific germicidal properties. They depend for their 
action on the presence of the freed haloid substance. 

Fluorine is too active a substance to be handled, and only in 
exceptional cases are bromine-liberating compounds applicable. 
The halogens are only useful in the presence of a certain amount 
of moisture. A 2 per cent, solution of chlorine water is capable 
of acting on the anthrax bacillus spores in 15 seconds, and in pro- 
portions of 1 : 700 it will completely prevent the development of 
this micro-organism. The disinfecting power of the chlorine-con- 
taining compounds is much enhanced if nascent chlorine is being 
formed. Chlorinated lime is a useful disinfectant for house pur- 
poses. Typhoid urine is well disinfected if the chlorinated lime 
is present in solution 1 : 500 to 1 : 1000 in five minutes. In the 
stools, the presence of albuminous material and salts make it im- 
perative to use this disinfectant as strong as 1 to 2 per cent., and 
have it act at least ten minutes. 



284 A TEXT-BOOK OF MA TERIA MEDICA. 

Iodine used locally is a powerful germicide and it may also be 
used internally. 

Iodine in combination with various aromatic or fatty bodies may 
be discussed here to advantage. The most characteristic of these 
bodies is iodoform. It is necessary that these bodies should liber- 
ate free iodine to be active germicides. 

Liquor Chlori Compositus— Liquoris Chlori Com- 
positi— Compound Solution of Chlorine. U. S. -P. 

Origin. — An aqueous solution of chlorine, containing when freshly prepared about 
0.4 per cent, of chlorine, with some oxides of chlorine and potassium chloride. 

Description and Properties. — A clear, greenish-yellow liquid, having the 
suffocating odor and disagreeable taste of chlorine, and leaving no residue on evapora- 
tion. Chlorine water, even when kept from light and air, is apt to deteriorate ; when 
it is required of full strength, it should be freshly prepared. 

Dose. — 1-4 fluidrams (3.7-15.0 Cc.) [1 dram (4 Cc), U. S. P.]. 

Antagonists and Incompatibles. — The salts of lead and silver 
are incompatible. 

Synergists. — The antiseptics are theorectically synergistic, 
though practically the drug is almost always used alone. 

Physiological Action. — Externally and Locally. — Chlorine 
water is a powerful antiseptic, germicide, and deodorant. When 
applied to the skin it acts as a rubefacient and vesicant, while the 
vapor is distinctly irritating to the respiratory passages. 

Internally. — Chlorine water is more or less irritating to the 
mucous membrane of the stomach, and possesses an astringent 
taste. 

Therapeutics. — Externally and Locally. — Chlorine water is still 
occasionally used as an antiseptic and deodorant in gangrenous or 
sloughing wounds and for disinfecting foul discharges, etc. It has 
proved beneficial as a local application in aphthous stomatitis, diph- 
theria , and parasitic skin diseases. 

Administration. — When given internally the drug should be 
well diluted. Should poisoning ensue from the ingestion of excess- 
ive amounts, albumen is the best antidote ; for the irritation occa- 
sioned by the inhalation of chlorine gas steam-inhalations are 
indicated. 

Calx Chlorinata— Calcis Chlorinatae— Chlorinated 

Lime. U. 8. P. 

Origin. — A compound resulting from the action of chlorine upon calcium hydrox- 
ide, and containing not less than 35 per cent, of available chlorine. 

Description and Properties. — A white or grayish-white, granular powder, 
exhaling the odor of hypochlorous acid; of a repulsive saline taste, and becoming 
moist and gradually decomposing on exposure to air. It is but partially soluble in 
water or alcohol. The drug should be kept in well-closed vessels, in a cool and dry 
place. Used externally. 

Physiological Action and Therapeutics. — Chlorinated lime is 
a powerful disinfectant, yielding, when exposed to air, hypochlorous 



HALOGENS. 285 

acid, which is resolved into chlorine and chloric acid, the last in 
turn yielding chlorine. 

The effects of the drug are therefore analogous to those of 
chlorine, yet almost the only use which chlorinated lime serves is 
in disinfecting cesspools and utensils employed for receiving the 
dejections of invalids. 

Liquor Sodae Chlorinatae— Liquoris Sodae Chlorin- 
atae— Solution of Chlorinated Soda. U. S. JP. 

(Labarraque's Solution.) 

Origin. — An aqueous solution of several chlorine compounds of sodium, contain- 
ing at least 2.4 per cent, by weight of available chlorine. 

Description and Properties.— A clear, pale-greenish liquid, having a faint 
odor of chlorine and a disagreeable alkaline taste. It should be kept in well -stoppered 
bottles, protected from light. Used externally. 

Physiological Action. — The action of the drug resembles that 
of aqua chlori, although it is feebler than the latter. 

Therapeutics. — Solution of chlorinated soda is used as a disin- 
fectant for fetid ulcers, gangrenous sores, and ozena, and as a disin- 
fectant wash in diseases of the uterus, vagina, and auditory canal. 

Administration. — There are no special directions to be ob- 
served in the application of this solution. 

Iodoformum— Iodoformi— Iodoform. U. S. P. 

Definition. — Triodomethane, usually obtained by the action of iodine upon 
alcohol, in the presence of an alkali or alkali carbonate. 

Description and Properties. — Small, lemon-yellow, lustrous crystals, of the 
hexagonal system, having a peculiar, very penetrating, and persistent odor, somewhat 
resembling that of saffron and iodine, and an unpleasant, slightly sweetish, and iodine- 
like taste. It is very slightly soluble in water, to which, however, it imparts its odor 
and taste ; soluble in about 46.7 parts of alcohol, in about 12 parts of boiling alcohol, 
or in 5.2 parts of ether, and very soluble in chloroform, benzin, and fixed and volatile 
oils. 

Iodoform is slightly volatile, even at ordinary temperatures, and in boiling water 
distils slowly over with its vapor. It should be kept in well-stoppered bottles, in a 
cool and dark place. 

Iodoform contains 96.69 per cent, of its weight as iodine. 

Dose. — 1-3 grains (0.06-0.2 Gm. ) [4 grains (.250 Gm.), U. S. P.]. 

Official Preparation. 

Unguentum Iodoformi — Unguenti Iodoformi — Ointment of Iodoform. — 

IO per cent. Used externally. 

Iodoium— Iodoli— Iodol. U. S. J\ 

Definition. — Tetraiodopyrrol, a derivative of the base pyrrol (C 4 H 5 N), obtained 
by the direct action of iodine upon the base in the presence of alcohol. 

Description and Properties. — A light, grayish-brown, crystalline powder 
without odor or taste. Very slightly soluble in water (1 14900), much more so in 
alcohol (1 : 9), soluble in fixed oils. 

Dose. — Average dose : 0.250 Gm. = 250 milligrammes (4 grains, U. S. P.). 

This is one of the vast number of compounds proposed in the last few years as 
substitutes for iodoform. The iodine of iodol is apparently less easily split off the 
molecule than that of iodoform, and it is said to be less liable to produce poisoning. 
Iodol contains about 88.57 per cent, of iodine. 



286 A TEXT-BOOK OF MA TERIA MEDICA. 

Allied Compounds. 

Antiseptol — Cinchonine Iodosulphate. — Origin. — It is prepared by mixing an 
aqueous solution of cinchonine sulphate with an aqueous solution of iodine and potas- 
sium iodide, and washing and drying the resulting precipitate. 

Description and Properties. — It occurs as a light reddish-brown powder, insoluble 
in water, but soluble in alcohol and chloroform. It contains about 50 per cent, of iodine. 

Dose. — 1-3 grains (0.06-0.2 Gm.). 

Aristol — Dithymol Diiodide. — Origin. — It is obtained by adding a solution of 
iodated iodide of potassium to an aqueous solution of hydrate of sodium containing thy- 
mol. The resulting precipitate is washed and subsequently dried at ordinary temperature. 

Description and Properties. — A dark, brownish-red, amorphous, almost tasteless 
powder, of a slight, peculiar, iodine-like odor, insoluble in water and glycerin, sparingly 
soluble in alcohol, but readily soluble in ether, collodion, and chloroform. It is also 
taken up by fixed oils, petrolatum, etc. 

Aristol is decomposed by heat and light, and it should be kept in dark amber- 
colored, well-stoppered bottles. It contains 45.8 per cent, of iodine. 

Dose. — It is not given internally. 

Europhen. — Prepared in a manner analogous to that of preparing aristol, expect 
that isobutylorthocresol is used in place of thymol. 

Description and Properties. — An amorphous, yellow powder, having an odor resem- 
bling saffron ; soluble in ether, chloroform, and fixed oils ; insoluble in water and 
glycerin. It is permanent in dry air, but when moistened with water resolves into iodine, 
forming a new soluble iodine compound. When heated to no C. (230 F.) it melts, 
forming a clear brown liquid. It contains 27.6 per cent, of iodine. 

Dose. — %-1 l /z grains (o.oi 6-0.09 Gm.). It is used hypodermically in olive oil, and 
externally in the form of an ointment, in strengths varying from 3 to 10 per cent. 

Antagonists and Incompatibles. — It is incompatible with the preparations of mercury 
and zinc, with metallic oxides, and with starch. 

Losophan. — Origin. — Prepared by slowly adding an aqueous solution of iodine 
and iodide of potassium to an aqueous solution of ortho-oxyparatoluic acid and sodium 
bicarbonate. The precipitate formed is washed with water and recrystallized from 
alcohol. 

Description and Properties. — It occurs as colorless, odorless, needle-shaped crystals. 
Insoluble in water and alcohol, but readily soluble in ether, benzene, chloroform, and 
fixed oils. It contains 78.39 per cent, of iodine. 

Dose. — It is used externally. 

Sozoiodol. — Origin. — A combination of iodine 54 per cent., carbolic acid 20 per 
cent., and sulphur 7 per cent. 

Description and Properties. — The sodium, potassium, ammonium, mercury, lead, 
and zinc salts of this acid are the preparations used, the sodium salt being the one most 
commonly employed. The sodium sozoiodolate occurs in bright, prismatic, needle-shaped 
crystals. Soluble in water, alcohol, and glycerin. 

Dose. — For external use, in strengths varying from 3 to 20 per cent. 

Sulphaminol. — Origin. — It is formed by the action of sulphur on the salts of 
metaoxydiphenylamine. 

Description and Properties. — It is a yellow powder, insoluble in water, readily sol- 
uble in alkalies, alcohol, and glacial acetic acid. 

Dose. — I to 4 grains (0.006—0.25 Gm. ). 

Other compounds of iodine used for much the same purposes are : Iatrol, aniline 
iodine, an antiseptic powder ; imidiol, a substitute for iodoform ; iodoanisol, a rube- 
facient and antiseptic ; iodocasein, a yellow powder with faint iodine odor ; iodocrol y 
carvol and potassium iodide and soda ; odorless substitute for iodoform ; iodoformal, 
with odor like vanilla, also an iodoform substitute ; iodoformogen t albumin and iodo- 
form ; iodogallicin, bismuth iodide and gallicin, antiseptic ; iodoterpin, iodin and terpin, 
dark-brown liquid, substitute for tincture of iodine or iodoform ; iodot/iymoform, an 
iodized thymol-formaldehyd preparation, a yellow powder rich in iodine. Nosop/ien, 
antinosine, eudoxine, are iodine compounds of phenol phthalein. Loretin and vioform, 
compounds of cresol and iodine. Airo/, a 20 per cent, iodine compound with bismuth and 
gallic acid. 

Antagonists and Incompatibles. — Iodoform is incompatible 
with mercuric chloride. 

Physiological Action. — Externally and Locally. — Iodoform or- 



HALOGENS. 287 

dinarily possesses no irritating action when applied to the skin or 
mucous membranes, or to ulcers and wounds. On the contrary, 
it possesses analgesic properties. It has a tendency to check serous 
oozing when applied to wounds. It has a limited action in hinder- 
ing the growth of bacteria when in alkaline serum, but as a dry 
powder it seems to possess little bactericidal action. 

Internally. — Digestive System. — Small doses, if they have any 
effect, slighly increase the appetite, and tend to increase the sali- 
vary, biliary, and intestinal secretions. Large doses disturb the 
stomach, and may occasion nausea, vomiting, and diarrhea. 

Nervous System. — Large doses are apt to produce headache, 
restlessness, delirium, or stupor. The reflexes may be depressed, 
or in some cases choreic movements may appear. Muscular con- 
tractility and the excitability of the nerve-centers to external stimu- 
lation are lessened. 

Circulatory System. — Small doses retard and strengthen the 
pulse, and, for a brief period only, increase arterial tension. Full 
medicinal doses lessen arterial tension and render the pulse slower 
and weaker. Lethal doses rapidly accelerate the pulse, causing it 
to become irregular ; later, the action of the heart is slowed, and 
finally arrested in diastole, from paralysis of the cardiac muscle. 

Respiratory System. — Very large doses produce convulsive res- 
piratory movements. 

Absorption and Elimination. — Iodoform is absorbed from the 
stomach, or from mucous membranes or wounds to which it is 
applied. It is slowly absorbed from the alimentary canal, but readily 
absorbed from wounds. In the tissues it combines with the proteid 
molecules, and is retained in the system in part as potassium iodide 
and other iodides. Free iodoform is, however, found in the body, 
else poisoning would probably not develop. It is eliminated in 
all the secretions, and has been detected in the urine and saliva 
within one hour after its administration, traces of it being percep- 
tible in the secretions for three days. Iodine is liberated at the 
points of elimination, either as an iodate or as some organic com- 
pound of iodine, or both. The drug is also detected in the breath, 
though it is chiefly eliminated in the urine as alkaline sodium iodate, 
coloring the urine yellow. It should be remembered that iodoform 
is absorbed much more rapidly than it is eliminated. 

Temperature. — Large doses cause a rise of temperature, while 
poisonous doses may, at the last, produce a decided reduction of 
animal heat. 

Untoward Action. — Sometimes iodoform excites an eczematous 
eruption, which may be papular or erythematous, and symptoms of 
vertigo. Muscular weakness and double vision have also been 
observed ; sleepiness, alternating with excitement ; incoherence of 
speech ; headache ; mental confusion ; and amblyopia. 

Poisoning. — Three forms of poisoning by iodoform are described 
by Duret — the eruptive, the cerebral, and the syncopal. The rela- 
tion of iodoform to the methane group is to be borne in mind. 



288 A TEXT-BOOK OF MA TERIA MEDICA. 

No two cases of poisoning present the same symptoms, hence 
every case should be considered a law unto itself and be treated 
accordingly. With reference to fatal doses, 75 grains (5 Gm.), 
administered over a period of one week, have caused death. 

In the first of these there may be a severe and extensive ery- 
thema or eczematous eruption. The cerebral variety is character- 
ized by an increase of temperature and accelerated pulse — as high 
as 150 or 175 per minute; great irritation of the gastro-intestinal 
tract ; widely dilated, or motionless and contracted, pupils ; intense 
headache over the entire circumference of the head ; insomnia, rest- 
lessness, melancholia ; great depression of spirits or hallucinations 
and active delirium or suicidal mania. 

In the syncopal variety the patient complains of dizziness and 
mental confusion ; is languid and weak ; he suffers from insomnia, 
is restless, and unable to keep quiet. He may develop hallucina- 
tions either of an exciting or depressing nature, and may develop 
violent delirium ; the heart's action becomes very rapid and feeble, 
the patient passing at length into a lethargic or comatose condition, 
with paralysis of the sphincters, and finally dying, perhaps quite 
suddenly. 

The symptoms of poisoning may appear soon after the applica- 
tion of the drug, or they may be deferred for days and even weeks. 
In the latter case, which may properly be termed chronic poison- 
ing, the patient is more apt to be depressed, weak, and apathetic 
with slight fever and accelerated pulse. Old people are the more 
susceptible to its toxic influence. 

Treatment of Poisoning. — Every particle of the drug should be 
immediately removed from the body and its internal administration 
be discontinued at once. Stimulants, diaphoretics, and diuretics 
should be given, with frequent bathing of the body in warm water, 
to hasten elimination. Opium and large doses of potassium bicar- 
bonate have been recommended. 

Therapeutics. — Externally and Locally, — Iodoform acts as an 
alterative, analgesic, protectant, antiseptic, and germicide to at least 
some forms of bacilli. Its extremely disagreeable odor does not 
commend it for anything. Odorless compounds with similar actions 
are much to be preferred. It is a valuable application to wounds y 
idcers, etc. It is especially valuable in the treatment of tuberculous 
affections , such as tuberculous joints, when it is used in the form of 
an injection — 10 to 20 per cent. — in sterilized olive oil. In tuber- 
cidous parenchymatous synovitis the mixture is injected directly into 
the joint-cavity. 

Iodoform is an exceedingly valuable application to syphilitic 
ulcers, chancres, chancroids, suppurating buboes, ulcerations of the 
uterus \ uterine cancer, and indolent and irritable ulcerations of the leg. 

Incorporated in a suppository, it is very efficacious in painful 
hemorrhoids, fistula, and fissure of the anus. 

It is a valuable application in many diseases of the ear, nose, 
throat, eye, and skin, where a drug of this character is indicated. 



AROMA TIC AND FA TTY COMPOUNDS. 289 

Internally. — Iodoform is used but very little internally, and has 
no particular indications. 

The allied compounds here mentioned are used locally as sub- 
stitutes for iodoform. Most of them possess the great advantage 
of being odorless, and some of them seem to be in all respects 
quite as efficient as iodoform. Aristol is undoubtedly superior to 
it in the treatment of indolent ulcers and in many diseases of the 
skin, ear, nose, and throat. Europhen and iodol should certainly 
replace iodoform in many cases. 

Administration. — Internally, iodoform should be given in pills 
or capsules. Externally, it may be used in the form of a powder, 
alone or mixed with powdered borax or boric acid. It is also used 
in the form of an ointment or collodion. It is given hypodermi- 
cally, mixed with olive oil and glycerin, or dissolved in ether, in 
strengths varying from 10 to 30 per cent. 

Its disagreeable odor may be modified or disguised by mixing 
it with tar, liquid styrax, balsam of Peru, thymol, coumarin, 
menthol, ground coffee, oil of lavender, bergamot, bitter almond, 
coriander, musk, vanilla, or some similar aromatic and pleasantly 
odorous substance. At best, however, it is almost impossible to 
eradicate the disagreeable odor. 

V- AROMATIC AND FATTY COMPOUNDS. 

This group is a large one. The differing compounds, modifica- 
tions of the benzol nucleus, make a distinct series with closely 
related properties. 

Phenol— Phenolis— Phenol. V. S. JP. 

(Acidum Carbolicum, U. S. P., 1890.) 

Definition. — Hydroxybenzene, obtained either from coal tar by fractional distilla- 
tion and subsequent purification, or made synthetically. It should contain not less than 
96 per cent, of absolute phenol. 

Description and Properties. — Colorless, interlaced, or separate needle-shaped 
crystals, or a white, crystalline mass, sometimes acquiring a reddish tint, having a 
characteristic, somewhat aromatic, odor, and, when copiously diluted with water, a 
sweetish taste, with a slightly burning after-taste. Deliquescent on exposure to damp 
air. 

Soluble in about 19.6 parts of water, the solubility varying according to the degree 
of hydration of the acid; very soluble in alcohol, ether, chloroform, benzol, carbon 
disulphide, glycerin, and fixed and volatile oils. It is liquefied by the addition of about 
8 per cent, of water. The vapor of the acid is highly inflammable. Carbolic acid is 
faintly acid to litmus-paper. It should be kept in dark amber-colored, well-stoppered 
bottles. 

Dose.— Yz-i grains (0.03-0. 12 Gm.). If liquefied, 1-2 minims (0.03-0. 12 Cc.) 
[1 grain (0.65 Gm.), U. S. P.]. 

Official Preparations. 

Glyceritum Phenolis— Glyceriti Phenolis— Glycerite of Phenol (20 per cent.) 
[5 minims (0.3 Cc), U. S. P.]. — For external use. 

Unguentum Phenolis— Unguenti Phenolis— Ointment of Phenol (3 per 
cent.). — For external use. 
19 



290 A TEXT-BOOK OF MATERIA MEDICA. 

Phenol Liquefactum— Phenolis Liquefacti— 
Liquefied Phenol. 77. S. P. 

Definition. — A liquid composed of not less than 86.4 per cent., by weight, of 
absolute phenol and about 13.6 per cent., by weight, of water. 

It is prepared from phenol (Acidum Carbolicum, U. S. P., 1S90) by the addition 
of distilled water in the proportion of 1 Gm. of the latter to 9 Gm. of phenol. Intro- 
duced on account of the ease of dispensing. 

Dose. — Average dose : I minim (0.05 Cc). U. S. P. 

Physiological Action. — Externally. — Carbolic acid destroys 
micro-organisms. Spore -bearing forms are very resistant to its 
action. Two per cent, solutions are effective for many bacteria, but 
they are not always efficient as germicides. Phenol is a local 
anesthetic, and, applied in full stength to animal tissues, acts as a 
caustic, but does not produce vesication. In weaker solutions it 
produces a burning and reddening of the skin. It acts more 
severely upon mucous membranes. It coagulates albumin, and 
therefore its caustic action is limited. 

The eschar is first whitish, subsequently becoming brownish. 
It is readily absorbed through the skin or through raw surfaces, 
and toxic effects have been thus produced. Weak solutions, 2.5 
per cent, in contact with an area, such as a finger, may cause gan- 
grene of the parts. 

Internally. — Digestive System. — In small doses it is anesthetic 
and sedative to the stomach. In large or poisonous doses it is a 
powerful gastro-intestinal irritant. Ordinary medicinal doses are 
converted by the gastric contents into the sulphocarbolates. 

Nervous System. — Medicinal doses have no special effect upon 
the nervous system. Large or poisonous doses depress the cere- 
brum. Vertigo may first be noticed, which is soon followed by 
stupor. There may be muscular trembling or convulsions. 

Circulatory System. — Medicinal doses have no apparent effect on 
the circulation. Large doses first depress, and later accelerate, the 
heart. Poisonous doses powerfully depress the heart, stopping it 
in diastole. The arterial tension is lowered by lethal doses. 

Respiratory System. — Small doses do not affect the respiration. 
Large doses first accelerate the respiratory movements, rendering 
them full, but shallow respirations soon follow. This action is due 
to stimulation of the vagi, both at the periphery and of the center. 
If the dose has been a poisonous one, there is great depression, 
and ultimately paralysis of respiration due to depression of the 
centers. 

Absorption. — It is absorbed from the stomach, and diffuses into 
the blood with great facility, circulating in that tissue probably as 
an alkaline carbolate. 

Elimination. — It is eliminated by all the secretions — chiefly by 
the kidneys and lungs — and appears in the urine as salts of sulpho- 
carbolic and glycuronic acids, and to oxidated products of the 
dioxybenzoles, hydrochinon and pyrocatechin. To the latter sub- 
stances, after further oxidation, mainly is due the peculiar smoky 



AROMA TIC AND FA TTY COMPOUNDS. 291 

or olive-green color imparted to the urine after large or continued 
doses have been taken. Much of the phenol is eliminated unchanged. 

Temperature. — It is not specially affected by small doses. Full 
medicinal doses tend to lower bodily temperature in fever, while 
poisonous doses lower the temperature several degrees. The 
reduction of temperature is due to its diminishing heat-production 
and increasing heat-dissipation. 

Eye. — Poisonous doses almost invariably cause the pupil to be 
minutely contracted, due, probably, to paralysis of the radiating 
fibers, the circular fibers being unaffected. 

Untoward Action. — Headache, either in the frontal or the 
occipital region, heaviness and a sensation of fulness in the head, 
dizziness, and the appearance of rings before the eyes, muscular 
weakness, especially of the legs, profuse sweating, and extensive 
formication. 

Where there is an idiosyncrasy on the part of the individual 
against this drug, small doses even may produce the symptoms of 
poisoning. 

Poisoning. — Carbolic acid is one of the most widely used poisons. 
8.5 Gm. has caused the death of an adult in fifteen minutes. 3 Gm. 
in solution thrown into the pleura has caused dangerous symptoms. 
.13 Gm. rubbed on the skin has caused death. 1.5 Gm. has caused 
the death of a child after a short time. 

The patient is rendered rapidly unconscious or may drop dead 
in twelve to fifteen minutes after taking from respiratory paralysis. 
Should the dose be insufficient to produce so sudden a death, the 
patient suffers from all the symptoms of gastro-enteritis — intense 
pain, with violent vomiting of white slimy mucus and purging. 
Fibrillary trembling may be present. Stertorous breathing appears, 
with cold, clammy skin, pinched face, anxious expression, abolition 
of reflexes, weak, thready, and often imperceptible pulse, feeble 
respiration, and frequently dyspnea, and death finally occurs from 
failure of respiration. 

Salivation is a common symptom of carbolic-acid poisoning. 
The characteristic burn of the lips is whitish. The odor is an 
important diagnostic sign. 

As toxic symptoms may be produced by the external applica- 
tion of solutions of carbolic acid, as in surgical dressings or vagi- 
nal or intrauterine douches, the toxicity of this drug should be 
appreciated, and patients carefully watched for the first untoward 
manifestations, such as pain in the lumbar region, smoky urine, 
nervousness, and cerebral disturbance, small pulse, depressed tem- 
perature, hot and cold flashes, etc., when the drug should be imme- 
diately withdrawn. 

Treatment of Poisoning. — The immediate and frequent washing 
out of the stomach with administration of magnesium sulphate 
(Epsom salts), sugar and lime solution (lime water, sugar 3, and 
water 12), and warm demulcent drinks should be resorted to. The 
application of external heat. Atropine and strychnine hypoder- 



292 A TEXT-BOOK OF MATERIA MEDICA. 

mically. Digitalis and coffee may also be required. Opium, or 
some preparation of it, for the relief of pain. 

Alcohol is an efficient antidote if promptly given. Locally 
applied, it prevents the caustic action of even pure phenol. 

Therapeutics. — Externally and Locally. — For some time after 
it was so prominently brought forward by Lister carbolic acid 
was thought to be indispensable in antiseptic surgery. It is now 
known that the solutions which are safe to use are inefficient, ordi- 
narily, beyond the mere mechanical effect of washing. 

The benumbing influence produced on the hands of the sur- 
geon, and the discoloration of bright instruments and rapid impair- 
ment of their cutting surfaces, render strong solutions for disin- 
fecting instruments impracticable, and, indeed, of less value for this 
purpose than the prolonged boiling in distilled water rendered 
slightly alkaline with sodium bicarbonate. 

The pain of superficial burns is relieved by applying strong solu- 
tions of carbolic acid, care being taken to prevent absorption. 

It is an extremely valuable drug as an antipruritic, and is hence 
of great utility in the treatment of certain diseases of the skin — 
pruritus, chronic eczema. In chilblains, tinea tonsurans, tinea capitis, 
tcenia circinata, favus, etc., it is of value. Chronic laryngitis, 
characterized by diminished secretion, is greatly benefited by the 
direct application to the parts of a solution of \ dram to I ounce 
of glycerin (2.0-30.0 Cc). A spray containing from 2 to 5 grains 
(o 12-0.36 Gm.) to 1 ounce (30.0 Cc.) of water is an efficient appli- 
cation in the treatment of acute and chronic inflammation of the 
throat and nose. 

As a deodorant it is valuable to correct the fetor arising from 
syphilitic ulcerations, carcinoma, gangrene of the lungs, bronchor- 
rhea, pneumothorax, etc. 

It reduces the discharge and relieves the pain in acute otitis 
media: a 10 per cent, solution in glycerin should be used. It is 
also of value in the treatment of otorrhea and in acute perforations 
of the tympanic membrane, but should be used in much weaker 
solutions — 1 or 2 per cent. 

A lotion, 8 to 15 grains (0.5-1.0 Gm.) to 1 ounce (30.0 Cc), is 
an efficient antiseptic in foul and indolent ulcers. 

The pure acid is used as a cauterant in chancroids, lupus, gan- 
grene, bites of rabid animals, etc. 

The iodized carbolic acid is a valued local remedy in endometri- 
tis, chronic endocervicitis, and ulcers of the cervix. 

Crude carbolic acid is useful as a disinfectant. 

Internally. — While inferior to salicylic acid to check fermentation, 
it is nevertheless used for that purpose in dilatation of the stomach 
and so-called fermentative, or flatulent, dyspepsia. 

In nervous and irritative vomiting it may be given in doses of 
from 1 to 2 minims (0.06-0.12 Cc), well diluted and repeated at 
intervals of from one to four hours according to the symptoms 
of the case. 



AROMA TIC AND FA TTY COMPOUNDS. 293 

It has been used in acute and chronic dysentery, and as an anthel- 
mintic against ascarides and tcenia solium. 

It has also been advocated as a remedy for typhoid fever and in 
malarial cachexia, but purely upon hypothetical grounds, no clini- 
cal results having thus far justified its use in these disorders. 

Administration. — It may be given internally in pills or capsules, 
mixed with powdered licorice-root as an excipient, or dissolved in 
glycerin and well diluted with sweetened water. 

For external use various strengths are used (from 1 : 10 to 
1 : 500), and the various preparations mentioned may be used 
according to the case and indications. It is to be noted that a 
strength above 1 : 10 is liable to produce vesication, and that even 
in 2 per cent, solutions it has caused gangrene of the part to which 
it has for some time been applied. 

Cresol— Cresolis— Cresol. U. S. r. 

Definition. — A mixture (C 6 H 4 <qtt 3 ) of three isomeric cresols obtained from coal 

tar, freed from phenol, hydrocarbons, and water. 

Description and Properties, — A colorless or straw-colored refractive liquid 
having a phenol-like odor and turning yellowish-brown on prolonged exposure to light. 

Sometimes erroneously called crecylic acid. Cresol is methyl phenol, the three 
isomeric forms being known chemically as ortho-, meta-, and paracresol. 

Soluble in water (i : 60) and miscible in all proportions with alcohol and glycerin. 
Miscible with alkali hydroxide solutions, forming alkali cresolates, homologous with 
alkali phenolates. 

Dose. — Average dose: I minim (0.05 Cc). U. S. P. 

Hunt writes " much has been written concerning the germicidal 
and toxic properties of cresol. It is generally held that cresol is 
more toxic to bacteria than is phenol, but that it is less toxic to 
higher animals than is the latter." Tollens (Arch./, exper. Path. u. 
Pharm., lii., p. 220, 1905) finds that paracresol is more than twice 
as toxic for mice as is phenol, orthocresol has the same toxicity, 
while metacresol is less toxic. Thus the toxicity of a cresol will 
depend upon the relative proportion of the three constituents, and 
these seem to vary in different preparations ; Tollens finds some 
specimens to be more toxic than phenol. The U. S. Pharmacopoeia 
does not specifically state the proportions in which the three cresols 
are present, although it fixes limits for the boiling-point, specific 
gravity, and solubility. A preparation on the market under the 
name of tricresol (enterot) is said to contain 35 per cent, of ortho- 
cresol, 40 per cent, of metacresol, and 25 per cent, of paracresol ; 
it is soluble to the extent of 2.2 to 2.55 per cent, in water. The 
physiological action of the cresols is almost identical with that of 
phenol. 

The cresols are constituents of coal tar and other crude anti- 
septic substances. Being but slightly soluble in water, they are 
often used in the form of emulsions or are dissolved with the aid 
of salts or of soap. The official Liquor Cresolis Compositus {q. v.) 
belongs to the latter class ; it is practically identical with the Liquor 



294 A TEXT-BOOK OF MATERIA MEDICA. 

Cresoli saponatus of the German Pharmacopoeia and the prepara- 
tion on the market known as lysoL 

Liquor Cresolis Compositus— Liquoris Cresolis 
Compositus— Compound Solution of Cresol. 
V. S. JP. 

Definition. — Liquor Cresoli Saponatus is the official German title of a somewhat 
similar preparation. It is essentially a linseed-oil-soap solution of cresol of 50 per cent, 
strength ; the soap dissolves the cresol as do alkalies. This is a mixture of much 
more definite composition than many commercial preparations of similar nature. For 
practical use the 50 per cent, solution is diluted with water to various degrees accord- 
ing to need. 

(Crude Carbolic Acid and Cresols.) 

Within recent years a number of preparations made from the higher phenols of crude 
carbolic acid, particularly the cresols, have been placed on the market as disinfectants, 
and a word should be said concerning their composition and their usefulness. For the 
most part their composition is extremely complex. They are mixtures of many constit- 
uents. Some of the more commonly used are : 

1. Sapocarbol-Oresolin — " Carbolic Soaps." — This is a mixture of crude 
cresols (C 6 H 4 (OH)CH 3 ) with pyridin bases, hydrocarbons dissolved in resin soaps. 

2. Saprol. — A mixture of crude cresols, with petroleum remnants, hydrocarbons, 
and pyridin bases. 

3. Oreolin. — A mixture of the higher raw phenols from oil in resin soap with an 
alkaline reaction. Its composition is thought to be hydrocarbons, 45 per cent. ; phenols, 
13 per cent, (phenol, cresol, xylenol, phlorol) ; pyridin bases, 2-3 per cent. ; resin, 
32 per cent. ; water, 5-6 per cent. 

A j4~ 2 pe r cent, solution in water has been used as a germicide in obstetrics, but 
its cloudy appearance made it unpopular. 

4. Lysol. — A 50 per cent, solution of the comparatively pure cresols in potassium 
soap. It is a widely employed germicide in gynecology, and is very useful in y z -\ per 
cent, solution. 

It occasionally is swallowed by accident. I dram has killed a ten-months' -old child 
in thirty-six hours. 25 Gm. of lysol has been recovered from, although the symptoms 
were exceedingly severe. Poisoning has occurred by its use as a uterine douche. 

5. Salveol is a mixture of cresol in sodium cresotinate. 

6. Solutol. — A solution of crude cresols in sodium ciesolate. 

7. Tricresol. — A mixture of the three pure cresols. 

Orthometa- and paracresol, soluble in 2-2 y z parts of water, is used as an expecto- 
rant and respiratory antiseptic. 

The pure cresols are about as poisonous as phenol (Meili, Inaug. Dissert., Bern, 
1891), but the symptoms of poisoning may be somewhat delayed. As antiseptics 
Hammerl (Hygienische Rundschau, ix., No. 20) has shown that ortho- and paracresol 
are stronger than carbolic acid. 

Resorcinol— Resorcinolis— Resorcinol. TJ. S. JP. 

Definition.— A diatomic phenol [metadihydroxybenzene, C 6 H 4 (OH), 1 : 3] ob- 
tained usually by the reaction of fused sodium hydroxide upon sodium metabenzene- 
disulphonate. 

Origin. — Prepared by melting galbanum, ammoniac, or guaiacum resin with 
potassa. It is also prepared in a similar manner from asafetida, sagapenum, ascaroid 
resin, and from phenolsulphonic acid and other derivatives from phenol. 

Description and Properties.— Colorless or faintly reddish, needle-shaped 
crystals, or rhombic plates, having a faint, peculiar odor, and a disagreeable sweetish 
and afterward pungent taste. Resorcinol acquires a pinkish or brownish tint by expo- 
sure to light and air, and should be kept in dark amber-colored vials. It is soluble in 
0.5 part of water, more in alcohol, very soluble in boiling water and in boiling alcohol, 
readily soluble in ether and in tdveerin, and very slightly soluble in chloroform. The 
aqueous solution is neutral or only faintly acid to litmus-paper. 

Dose. — 3-8 grains (0.2-0.5 Gm.) [2 grains-. 125 Gm., U. S. P.]. 



AROMA TIC AND FA TTY COMPOUNDS. 295 

Allied and Derivative Compounds. 

Hydroquinol — Hydroquinone — Hydrochinone — Paradioxybenzene. — Color- 
less, odorless, dimorphous crystals, having a sweeti>h taste. Soluble in 17 parts of 
water, very soluble in hot water, alcohol, and ether. Dose, 1^-5 grains (0.03-0.30 
Gm.). 

Catechol — Pyrocatechin — Orthodioxybenzene. — Acicular crystals, readily sol- 
uble in water, alcohol, and ether. 

Other allied compounds are — thioresorcin, resopyrine, and fluorescein. 

Physiological Action. — Pyrocatechin, resorcin, and hydroqui- 
none, ortho-, meta- and paradioxybenzols, agree practically in all 
their actions. Pyrocatechin and resorcin are comparatively soluble 
in water. Hydroquinone is less so. They irritate the central 
nervous system, more particularly the spinal cord. Resorcin is the 
least irritating and poisonous of the three ; 10 Gm. has been 
taken without causing death. Pyrocatechin is the most active, both 
locally and internally. It is more poisonous than phenol. 

Therapeutics. — Externally and Locally. — Resorcin is especially 
useful in certain subacute or chronic skin affections, and may be 
used like salicylic acid in indurated eczema. It is of great value in 
psoriasis ■, seborrhea sicca, pityriasis capitis, sycosis, acne rosacea, etc. 

A 5 to 10 per cent, solution is an efficient application in pharyn- 
gitis, diphtheria, and ulcerative laryngitis. An ointment of resorcin 
is an excellent application to fold ulcers, sloughing wounds, and 
syphilitic ulcers. 

Condylomata have been cured by dusting upon them powdered 
resorcin. 

A mixture of powdered resorcin and boric acid (1 : 20 or 1 :io) 
has been used with brilliant results in suppuration of the middle 
ear. 

A 2 per cent, solution has been found useful in the form of a 
spray in whooping-cough, while stronger solutions of 10 or 20 per 
cent, have been used with some success in hay fever. 

Solutions of resorcin have been used in gonorrhea and cystitis. 

Internally. — Resorcin is preferable to carbolic acid for internal 
administration, especially in digestive disorders, such as gastralgia, 
chronic gastritis, idcer of the stomach, and fermentative dyspepsia, so 
called. Owing to its sedative and antifermentative properties, it is 
of value in acute diarrhea of children. 

It has been used with some success in intermittent fever, but 
.not with good results sufficiently uniform to justify the exclusion 
of quinine. As an antipyretic it may be used when a drug of that 
character is indicated, but it is not equal to antipyrine or acetanilid, 
and in doses sufficient to produce the desired reduction of tempera- 
ture it is too depressant to the heart. Its chief therapeutic value 
is for external or local use, and internally for the digestive disorders 
above mentioned. 

Administration. — It should be given in pills or capsules. 

The trioxybenzols, C 6 H 3 (OH) 3 , pyrogallol (1, 2, 3), oxhydro- 
chinon (1, 2, 4), and phloroglucin (1, 3, 5), are occasionally used in 



296 A TEXT-BOOK OF MATERIA MEDICA. 

medicine. Pyrogallol is widely employed as a hair dye, is also 
employed in the treatment of psoriasis, and widely used in pho- 
tography. It is highly poisonous. It behaves in a large measure 
like phenol, but in addition has a marked destructive action on the 
blood. Oxyhemoglobin is changed into methemoglobin and hemo- 
lysis also is energetic. 

Phloroglucin used internally causes a peculiar type of diabetes. 

Other hydrocarbons of this general group, such as benzol, 
toluol, xylol, are liquids and not useful, but naphthalin, a solid 
member of the series, and some of its derivatives, are therapeu- 
tically possible. 

Naphthalenum— Naphthaleni— Naphthalene. 

U. 8. P. 

Origin. — A hydrocarbon (C 10 H 8 ) obtained from coal-tar. 

Description and Properties. — Colorless, shining, transparent laminae, hav- 
ing a strong, characteristic odor resembling that of coal-tar, and a burning, aromatic 
taste; slowly volatilized on exposure to air. Insoluble in water, but when boiled in it 
imparting a faint odor and taste. Soluble in 15 parts of alcohol, and very soluble in 
boiling alcohol ; also very soluble in ether, chloroform, carbon disulphide, and in fixed 
or volatile oils. Naphthalene volatilizes slowly at ordinary temperatures, but rapidly 
when heated. Its vapor is inflammable, burning with a luminous and smoky flame. 
It should be kept in well-stoppered bottles. 

Dose. — 2-10 grains (0.12-0.6 Gm.)[ 2 grains (0.125 Gm.), U. S. P.]. 

Beta-naphthol— Beta-naphthol— Beta-naphthol. 

V. S. B. 

Origin. — A monatomic phenol occurring in coal-tar, but usually prepared artificially 
from naphthalene. 

Description and Properties.— Colorless or pale buff-colored, shining, crys- 
talline laminae, or a white or yellowish-white crystalline powder, having a faint, 
phenol-like odor, and a sharp, pungent, but not persistent, taste. Permanent in the 
air. Soluble in about 95 parts of water, in 0.6 part of alcohol at 25 C. (77 F.), in 
about 75 parts of boiling water, and very soluble in boiling alcohol, ether, chloro- 
form, and solutions of caustic alkalies. It should be kept in dark amber-colored, 
well-stoppered bottles. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 

Antagonists and Incompatibles. — Physiological antagonists 
of naphthalene are the same as for other members of this group. 
Beta-naphthol is incompatible with subacetate of lead. 

Synergists. — Carbolic acid and its derivatives. 

Physiological Action. — Naphthalene is antiseptic, antifer- 
mentative, disinfectant, and deodorant. Its action is quite similar 
to phenol. It is insoluble in the gastric juices, but to some extent 
soluble in the intestines, where it acts as an antiseptic by local 
contact, deodorizing the stools and often imparting to them its own 
odor. It is absorbed to some extent, and is eliminated by the 
lungs and kidneys, but escapes principally in the feces. It has been 
known to irritate the kidneys. It is broken up into naphthol or 
dioxynaphthalene, and acts as a local antiseptic and disinfectant at 
points of elimination, but does not occasion any local irritation 
unless quite large doses have been taken: 15 grains (i.oGm.) 



AROMA TIC AND FA TTY COMPOUNDS. 297 

daily have occasioned frequent micturition, with burning pain, 
vesical tenesmus, and redness of the urethral orifice. Purdy states 
that in certain cases of genito-urinary disease he has known a dose 
of 5 grains (0.32 Gm.) to cause severe suffering along the whole 
urinary tract. It is a stimulant expectorant. Its use is thought to 
bring about a cloudiness of the crystallined lens. 

Beta-naphthol is quickly absorbed when applied locally. It 
produces considerable irritation when used in solution, but has no 
irritating effect when applied in the form of ointment. Toxic effects 
may result from its absorption by the skin, their character resem- 
bling the action of carbolic acid. 

Therapeutics. — Externally and Locally. — Naphthalene is 
recommended in the treatment of scabies and other parasitic skin 
diseases. 

Internally. — It is used in typhoid fever and in the g astro-intestinal 
and genito-urinary disorders for which salol and carbolic acid are 
administered, such as chronic diarrhea and dysentery, acute or 
chronic cystitis, etc. 

The internal uses of Beta-naphthol are the same as those of 
naphthalene, while externally it may be employed, like carbolic acid 
or creasote, as a general antiseptic in cutaneous disorders, whether 
organic or parasitic. 

Allied Compounds. 

Alumnol. — An almost colorless, non-hygroscopic powder ; readily soluble in 
cold water or glycerin, less soluble in alcohol, and insoluble in ether. It is employed 
as a local remedy in solutions varying in strength from I to 50 per cent. Used exter- 
nally. It is aluminium naphtholdisulphonate. 

Asaprol. — A colorless, neutral crystalline powder, soluble in 1^ parts of water 
and 3 parts of alcohol. — Dose, 15-60 grains (1.0-4.0 Gm.). Beta-naphthol sodium 
sulphonate. It is prescribed as an antipyretic. 

Benzonaphthol. — Obtained by the action of benzoic-chloride on beta-naphthol 
in a sand-bath. It is an odorless, tasteless, white, crystalline powder, or occurs in the 
form of long needles. Insoluble in cold water. Dose, 4-8 grains (0.18-0.5 Gm.). 

Betol {Naphtosalol — Salinaphthol). — A substance analogous to salol, and pre- 
pared in the same manner, except that sodium-naphthol is used instead of sodium- 
phenol. It occurs as a colorless, odorless, tasteless, lustrous crystalline powder. 
Insoluble in water or glycerin, and with difficulty soluble in cold alcohol. Dose, 2-5 
grains (0.12-0.3 Gm.). 

Camphorated Naphthol. — Obtained by mixing I part of beta-naphthol with 2 
parts of camphor. It is a brownish, transparent, syrupy liquid. 

Hydronaphthol. — A derivative of beta-naphthol, obtained by the action of 
reducing agents. It occurs in scale-like crystals, of a silvery-white or grayish hue, of 
slightly aromatic odor and taste. Soluble in 1 100 parts of water, and freely soluble 
in alcohol, ether, glycerin, benzene, chloroform, and fixed oils. Dose, 2-3 grains (0.12- 
0.18 Gm.). 

Asaprol, betol, and hydronaphthol are best given in cap- 
sules, although betol, which is tasteless and insoluble in water, may 
be administered in the form of powders. 

Alumnol. — An efficient remedy in many acute and chronic in- 
flammatory diseases of the skm, and in gonorrhea, chancres, syp- 
hilitic ulcers, balanitis, etc. A 1 per cent, solution may be injected 
in gonorrhea, while stronger solutions (10-50 per cent.), or alum- 
nol plaster, are recommended in chronic diseases of the skin. 



298 A TEXT-BOOK OF MATERIA MEDICA. 

Asaprol. — Given for the same purposes as salicylic acid and 
the salicylates, although it is not so uniformly successful in acute 
articular rheumatism, while having the advantage of causing less 
heart-depression. 

Betol. — Used chiefly in the bowel complaints of children. It 
may be administered either by the mouth or through the rectum, 
associated with bismuth or antacids. It has been used also in acute 
articular rheumatism and bladder affections. 

Camphorated xaphthol is considered by some practitioners 
to be superior to all other remedies to prevent suppuration in acute 
tonsillitis. 

Fernet has employed it successfully in tuberculous ulcerations of 
the tongue, while Reboul, of Marseilles, and others have adopted it 
with good effect hypodermically in tuberculous adenitis and tuber- 
culosis of the testis. It has also been used in tuberculosis of the 
bladder, joints, etc. 

Ruault claims it to be an efficient local application to the turbi- 
nated bones in ozena. 

Hydroxaphthol. — Considered by many physicians to be superior 
to carbolic acid, since it is without disagreeable odor and can be 
used without exciting irritation or danger of toxic impression. 

Dockreli employs it in the form of a plaster for destroying the 
trichophyton fungus of tinea tonsurans, and believes it to be superior 
to mercuric chloride as a germicide. 

It has been used as a preventive of dental caries, and in the 
treatment of gingivitis, pyorrhea alveolaris, diphtheria, etc. 

Internally it has been recommeuded in dysentery, diarrhea, pul- 
monary tuberculosis^ and typhoid fever. 

Contraindications. — These preparations should not be given 
internally when the functional activity of the kidneys is defective. 

Administration. — Naphthalene is best given internally in the 
form of pills or in capsules. When it is necessary to use it top- 
ically, the offensive odor of the drug may be disguised, it is said, 
by triturating it with a small quantity of the oil of bergamot. 
Beta-naphthol should be given in capsules, in the dose recom- 
mended, three times a day or oftener if necessary. 

THE PHENOL ETHERS. 

To this group belong creosote and its constituents. The most 
important of these phenol ethers are : 

1. Anisol: Methylphenol ether, C r ,H,OCH 3 . 

2. Phenetol : Ethylphenol ether, C 6 H 6 OC 2 H 5 . 

3. Guaiacol: Monomethyl ether of pvrocatechin, C f) H 4 OH.OCH 3 . 

4. Creosol : Methylguaiacol, C f) H 3 CH,OCH,OH. 

5. Creosote : A mixture of varying composition of 60-90 per 
cent., guaiacol, creosol, methylcreosol, CJT>.CH 3 ,CH.,,C)CH 3 ,OH, 
xylenol, C 6 H 3 CH 3 CH 3 OH, and phlorol, C 6 H 4 C 2 H 5 OH, and usually 
made of beechwood. 



AROMA TIC AND FA TTY COMPOUNDS. 299 

Creosotes of commerce from species of pine consist of much 
less guaiacol, more creosol, phenols, cresols, veratrol, and hydrocar- 
bons. Pure beechwood creosote should not contain any phenols 
or cresols. 



Creosotum— Creosoti— Creosote. V. S. JP. 

Origin. — A mixture of phenols and phenol derivatives, chiefly guaiacol and creo- 
sol, obtained during the distillation of wood-tar, preferably that derived from the 
Fagus silvatica L. or Fagus ferruginea Ait. beech. 

Description and Properties. — An almost colorless, yellowish or pinkish, 
highly refractive, oily liquid, having a penetrating smoky odor, and a burning, caustic 
taste ; usually becoming darker in tint on exposure to light. Soluble in about 150 
parts of water, but without forming a perfectly clear solution. With 120 parts of hot 
water it forms a clear liquid which on cooling becomes turbid, from the separation of 
minute oily drops. Soluble in all proportions in absolute alcohol, in ether, chloro- 
form, benzin, carbon disulphide, acetic acid, and in fixed and volatile oils. Creosote 
is inflammable, burning with a luminous, smoky flame. It is neutral, or only faintly 
acid, to litmus-paper. 

Dose-— 1-5 minims (0.06-0.3 Cc - ) [3 minims (0.2 Cc), U. S. P.]. 

Official Preparations. 

Aqua Creosoti — Aquae Creosoti — Creosote Water. — Dose, 1-4 fluidrams 
(4.0-15.0 Cc.) [2 drams (8 Cc), U. S. P.]. 

Incompatibles. — Strong sulphuric and nitric acids. It reduces 
silver salts, and explodes when combined with oxide of silver. 

Synergists. — The same as for carbolic acid. 

Physiological Action. — Externally. — It has an action similar 
to phenol. 

Internally. — Its action upon the digestive, circulatory, nervous, 
and respiratory systems is practically the same as that of carbolic 
acid. 

It does not stimulate the spinal cord so much as carbolic acid, 
and differs also from the latter drug in increasing the coagulability 
of the blood. Poisonous doses act like those of carbolic acid, but 
with more marked nervous symptoms. 

Absorption and Elimination. — It is eliminated by the bronchial 
mucous membrane, and by the kidneys as guaiacol sulphate and 
creosol sulphate of potassium. 

It is a stimulant expectorant. 

It has the property when applied to meat of preserving it, 
whence its name (creas, flesh, sohzote, preserve). 

Poisoning. — The symptoms and treatment of poisoning from 
creosote are the same as described under Carbolic Acid. 

Therapeutics. — Externally and Locally. — Creosote is superior 
to carbolic acid as an antipruritic, although not so generally used 
as the latter, on account of its acrid and penetrating odor. It can 
be used externally for the same purposes as carbolic acid. It is a 
valuable hemostatic, and the creosote water may be used for this 
purpose. 

Inhalations of creosote are recommended in phthisis, chronic 



300 A TEXT-BOOK OF MATERIA MEDICA. 

bronchitis, and chronic congestion of the larynx and trachea. It is a 
powerful local anesthetic, and is largely used by dentists and the 
laity for aching teeth. It is used to preserve dead animal matter for 
dissection, etc. 

Internally. — Creosote can be used internally for the same pur- 
poses as carbolic acid, having the advantage over the latter drug in 
being one of the most efficient remedies in pulmonary tuberculosis. 
Probably no one remedy exerts so favorable an action upon the 
night sweats, cough, and expectoration as creosote, or guaiacol, 
which is preferred by many physicians. It is of less value in cases 
accompanied by high temperature and hemoptysis, and often aggra- 
vates these symptoms. 

It must be remembered that many of the cases alleged to have 
been cured by creosote have been treated with cod-liver oil, tonics, 
and hygienic methods as well. Creosote undoubtedly limits the 
amount of secondary infections in phthisis and it is also stomachic. 
Many patients do badly with creosote and eminent phthisiologists 
deprecate its use. 

Contraindications. — The same as for carbolic acid. 

Administration. — Pure beechwood creosote alone should be 
used. It may be given in the form of creosote water, emulsion, or 
pills, or in capsules mixed with cod-liver oil. Capsules are the 
least offensive way of administration. Some persons prefer to take 
the drug in milk. 

In the treatment of phthisis large doses are necessary. A tol- 
erance can usually be established by gradually increasing doses. 
If the patient manifest any untoward symptoms, the drug must be 
reduced in quantity or discontinued altogether. 

Guaiacol— Guaiacolis— Guaiacol. U. S. JP. 

Definition. — One of the chief constituents of creosote ; prepared either from 
beechwood tar, or synthetically. 

Description and Properties. — Either a clear, colorless or light yellow, oily 
fluid, or colorless, prismatic crystals, which melt at 28. 5 C. It has an agreeable aro- 
matic odor. 

Chemically it is the monomethyl ether of pyrocatechin (orthodihydroxy-benzene), 
C 6 H 4 (OH)(OCH 3 ) 1:2. 

Soluble in water (1 :$$), glycerin (1 : i), and easily in alcohol. Being phenolic 
in character, it readily dissolves in caustic alkalies and forms salts with a large number 
of acids, one of which (the carbonate) has been made official. Of late years creosote 
has been largely superseded by guaiacol, upon which the value of creosote in large part 
depends. 

Dose. — 2-10 minims (0.12-0.6 Cc. ). 

The following derivatives have been introduced: 

Guaiacolis Carbonas — Guaiacolis Carbonatis — Guaiacol Carbonate (U. S. 
P.). — Definition. — A guaiacol derivative (C 6 H 4 (OCH 8 )0) 2 . CO, obtained by the action 
of carbonyl chloride upon sodium-guaiacolate. Also known as duotal. 

Description and Properties. — A white, crystalline, neutral powder, nearly odorless 
and tasteless. Insoluble in water; soluble in cold (i 548), more so in hot, alcohol ; 
slightly soluble in glycerin and fatty oils. 

D '•. — Average dose: 15 grains (1 Gm.), U. S. P. 

Guaiacolis Benzoas — Guaiacolis Benzoatis — Guaiacol Benzoate(BENZOSOL). 



AROMA TIC AND FA TTY COMPOUNDS, 301 

— Origin, by heating on a water bath potassium guaiacol with benzosol-chloride : the 
impure benzosal-guaiacol formed is purified by recrystallization from alcohol. 

Description and Properties. — Colorless, tasteless, and odorless crystalline powder, 
almost insoluble in water, but readily soluble in ether, chloroform, and hot alcohol. 

Dose. — 10-150 grains (0.60-10 Gm. ) daily. 

Guaiacolis Diiodidum — Guaiacolis Diiodidi — Guaiacol Diiodide. — Origin, 
by adding a solution of iodine in potassium iodide to an aqueous solution of sodium- 
guaiacol as long as precipitation continues. 

Description and Properties. — Reddish-brown salt, having the odor of iodine, sol- 
uble in alcohol and fixed oils, and readily decomposed. 

Dose. — 2-15 grains (o. 10-1 Gm.). 

Guaiacolis Salicylas — Guaiacolis Salicylatis — Guaiacol Salicylate (Guaia- 
COL-salol). — Origin, by the action of phosphorous oxychloride on a mixture of 
sodium-guaiacol and salicylate. It is analogous to salol. 

Description and Properties. — White, crystalline, odorless, and tasteless powder, 
insoluble in water, but soluble in alcohol, ether, and chloroform. 

Dose. — 10-150 grains (0.60-IO Gm.) daily. 

Physiological Action of Guaiacol and its Derivatives. — 
Guaiacol produces an action very similar to that of creosote. It is 
not caustic when applied in full strength. It possesses marked 
antipyretic properties. It is readily absorbed through the unbroken 
skin, and rapidly reduces febrile temperature when applied in this 
manner. The reduction of temperature lasts from four to six hours. 

It is a diaphoretic and diuretic. It is excreted by the sweat, 
saliva, and urine, but is only slighly thrown out by the expired 
air, though small amounts of the drug have been found in the 
lung-tissue. As it is eliminated as a salt of ethyl-sulphuric acid, it 
must combine with albuminous bodies in the blood, and chiefly 
through the sulphur present in the albumin molecule. It can be 
found in the urine within fifteen minutes after administration or 
external application in the form of a substance giving the reaction 
of phenol. 

It is more agreeable to the stomach than creosote, and fre- 
quently improves the appetite, though to some patients it is very 
disagreeable and acts as an irritant. 

The guaiacol carbonate is usually much better borne by the 
stomach, and is therefore a useful and efficient substitute. 

Benzosol, guaiacol benzoate, contains 54 per cent, of guaia- 
col. It is usually well borne by the patient, and seldom occasions 
any digestive disturbance. In the intestinal canal it resolves into 
guaiacol and benzoic acid, and is excreted by the urine as combi- 
nations of these substances. 

Therapeutics. — Guaiacol is used for the same purposes as 
creosote — less likely to irritate the intestinal canal and kidneys. 

Guaiacol causes a marked reduction of the temperature in cases 
of tuberculous disease when applied locally, nor is the antipyretic 
action when thus employed confined to tuberculous cases. It has 
given satisfactory results in other pyrexias. It is a very active 
antipyretic in erysipelas. The temperature begins to fall within 
fifteen or twenty minutes after the application of the drug. As 
with all antipyretics, the depressing action of guaiacol must be 
borne in mind. 



302 A TEXT-BOOK OF MA TERIA MEDICA. 

Raymond first suggested the local application of guaiacol in 
tonsillitis. It undoubtedly exerts a favorable action on the disease. 

Contraindications. — The same as for creosote. 

Administration. — The solid derivatives of guaiacol may be 
given in powders or capsules. Guaiacol itself may be given in 
the same manner as creosote — preferably, mixed with cod-liver 
oil or enclosed in capsules. 

Sodii Phenolsulphonas— Sodii Phenolsulphonatis— 
Sodium Phenolsulphonate. 17". S. P. 

(Sodium Sulphocarbolate. U. S. P., 1900.) 

Description and Properties. — Colorless, transparent, rhombic prisms, odor- 
less, having a cooling, saline, slightly bitter taste. Somewhat efflorescent in dry air. 
Soluble in 4.8 parts of water, 132 parts of alcohol, 0.7 part of boiling water, and in 
10 parts of boiling alcohol. The aqueous solution is neutral to litmus-paper. It 
should contain not less than 90 per cent, of pure sodium. Paraphenolsulphonate, 
C 6 H 4 (OH)S0 4 Na). 

Dose. — 10-30 grains (0.60-2 Gm.). 

Allied Compounds. 

Potassii Sulphocarbolas — Potassii Sulphocarbolatis — Potassium Sulpho- 
carbolate. 

Calcii Sulphocarbolas — Calcii Sulphocarbolatis — Calcium Sulphocarbo- 
late. 

Magnesii Sulphocarbolas— Magnesii Sulphocarbolatis — Magnesium Sul- 
phocarbolate. 

Zinci Sulphocarbolas — Zincii Sulphocarbolatis — Zinc Sulphocarbolate. 

All of the above have been employed, but the zinc sulphocarbolate is believed to 
be preferable to check diarrhea, and render the stools less foul. It is best given in 
pills, in doses of 2-3 grains (o. 1-0.15 Gm.). 

Physiological Action. — In medicinal doses sodium phenol- 
sulphonate occasions no special symptoms, and in three or four 
times the medicinal dose it causes only slight lightness of the head. 

It is changed in the system into carbolic acid and sodium sul- 
phate, the latter being eliminated with the urine. The carbolic 
acid set free exerts its characteristic action and influence. 

Therapeutics. — Externally and Locally. — In the strength of 
\ dram (2.0 Gm.) to 8 ounces (237.0 Cc.) of water it forms a 
valuable gargle in relaxed conditions of the throat. 

Solutions of different strengths have been used in diphtheria, 
acute tonsillitis, aphthce of children, and nasal catarrh. 

Thirty grains (2.0 Gm.) in 2 ounces (60.0 Cc.) each, of water, and 
hydrogen peroxide make an efficient injection in gonorrhea. 

Internally. — It is a mild intestinal antiseptic, and may be used 
internally for the same purposes as carbolic acid in such disorders 
as diarrhea, fermentative dyspepsia, etc. It arrests the growth of 
thrush, and is considered by some physicians to exert a favorable 
action in anginose scarlatina, diphtheria, and typhoid fever. The 
zinc SULPHOCARBOLATE is one of the best intestinal antiseptics to 
use in cases of dyspeptic diarrhea of children. 



AROMA TIC AND FA TTY COMPOUNDS. 303 

Administration. — Sodium phenolsulphonate is best given in 
solution. 

Ichthyolum— Ichthyoli— Ichthyol. (Non-official.) 

Origin. — It is obtained by the destructive distillation of bituminous rock found 
near Seefeld in the Tyrolese Alps, which contains enormous quantities of semifossihzed 
fishes and marine animals. 

Description and Properties. — It occurs in the form of a brownish-yellow, 
transparent, oily liquid, containing about 10 per cent, of sulphur. 

Upon being treated with concentrated sulphuric acid ichthyol is converted into 
ichthyol-sulphonic acid, which readily combines with ammonia and other alkalies, as 
well as with lithium, zinc, mercury, etc., forming the ammonium ichthyol, sodium 
ichthyol, zinc ichthyol, etc. 

Ammonium ichthyol occurs as a clear reddish-brown, syrupy liquid with a bitu- 
minous odor and taste. Soluble in water and in a mixture of equal volumes of ether 
and alcohol. 

Dose. — 2-10 minims (0.12-0.6 Cc). 

The other salts of ichthyol-sulphonic acid occur as brownish or black tar-like masses, 
the sodium salt being the most important, as it is the one most employed when ichthyol 
is desirable in pill form. 

Dose. — Sodium ichthyol, 2-4 grains (0.1-0.25 Gm.). 

Allied Drugs. 

Thiolum — Thioli — Thiol. — Origin. — This substance is prepared by heating 
brown-colored paraffin or gas oils with sulphur, and extracting the sulphurated, unsatu- 
rated hydrocarbons with alcohol. 

Description and Properties. — It occurs as a neutral, solid body, non-hygroscopic and 
soluble in water, and of a dark-brown color, or in the form of a dark reddish-brown, 
syrupy liquid, containing about 40 per cent, of thiol. 

Dose. — y^—1 grain (0.03-0.06 Gm.). 

Tumenolum — Tumenoli — Tumenol. — Origin. — It is obtained from purified 
mineral oils by the direct action of concentrated sulphuric acid, without previous sul- 
phuration, being a mixture of sulphones and sulphonic acids. 

Description and Properties. — A dark-brown or blackish-brown liquid of a syrupy 
consistence. 

Dose. — It is used only externally, in strengths of from 5 to 10 per cent. 

Antagonists and Incompatibles. — Ichthyol possesses marked 
reducing properties, and should not therefore be combined with 
substances, like potassium permanganate, which part readily with 
oxygen. 

Synergists. — Most members of this group, particularly the tars, 
carbolic acid, creosote, etc., aid its action. 

Physiological Action. — Externally and Locally. — Ichthyol is 
ischemic, sedative, parasiticide, and possesses antiseptic and prob- 
ably disinfectant, properties. 

When applied to the skin in full strength it produces some irri- 
tation. It is readily absorbed, having the power to penetrate the 
skin, affecting the deeper tissues beneath. 

Internally. — Digestive System.— Very large doses produce con- 
siderable gastro-intestinal irritation. 

Circulatory System. — It has the power in medicinal doses of 
contracting the caliber of the arteries, and in large doses it increases 
the migration of the white blood-corpuscles. 

The physiological action has not been fully studied, and it is 



304 A TEXT-BOOK OF MA TERIA MEDICA. 

not yet positively known what action it has upon the nervous and 
respiratory systems and upon temperature. 

Therapeutics. — Externally and Locally. — Ichthyol was intro- 
duced by Unna as a valuable remedy in certain diseases of the 
skin. It is particularly useful in erythematous eczema, erysipelas, 
lupus erythematosus, irritable acne, and certain forms of acne rosacea. 

Agnew has employed it with advantage in lymphatic enlarge- 
ments. It has also been found useful in synovial inflammations, in- 
flammatory conditions of the female genital organs, and in certain 
diseases of the ear and nose. 

Thiol, although inferior, is similar to ichthyol in its therapeutic 
action. It has been found to be valuable in the treatment of herpes 
zoster, dermatitis herpetiformis, and erythema multiforme. 

Administration. — Ichthyol, when given internally, should be 
dispensed in capsules, while thiol may be given in capsules, pills, 
or wine. 

Externally, ichthyol may be employed in solution, dissolved in 
chloroform or in a mixture of alcohol and ether, and applied with 
a brush ; or in the form of an ointment mixed with soft petrolatum 
or lanolin in from 1-4 to 8 drams (4-15 Cc. to 32 Gm.). It is used 
also in the form of a soap in from 5 to 20 per cent, strength. 

Thiol is used locally in powder form, or as an ointment of 5 to 
10 per cent, of the liquid, or in collodion containing 5 per cent, of 
the powder, or in solutions of glycerin and aqueous solutions con- 
taining from 5 to 50 per cent, of the powder. 

AROMATIC ACIDS. 

These are characterized by their greatly reduced toxic action by 
means of the introduction of the acid radical, COOH. The most 
important are benzoic acid, C 6 H 5 COOH, and ortho-oxybenzoic acid 
or salicylic acid, C 6 H 4 OH COOH. 

Benzoinum— Benzoini— Benzoin. U. S. P. 

Origin. — A balsamic resin obtained from Slyrax Benzoin Dryander and other un- 
identified species of Styrax. A large tree indigenous in Sumatra and Java, and prob- 
ably in Cochin-China and Siam. 

Description and Properties. — Benzoin exudes from incisions in the bark, 
and upon exposure to the air hardens into lumps consisting of agglutinated, yellowish- 
brown tears, which are internally milk-white, or in the form of a reddish-brown mass, 
more or less mottled from whitish tears imbedded in it. It is almost wholly soluble in 
5 parts of moderately warm alcohol and in solutions of the fixed alkalies. When heated 
it gives oft fumes of benzoic acid. It has an agreeable balsamic odor and a slight 
aromatic taste. 

Benzoin is of the nature of a balsam, containing from 20 to 24 per cent, of benzoic 
acid, resin, and volatile oil. Some varieties contain cinnamic acid, which is undesirable, 
while the benzoin from Siam contains vanillin and possesses the odor of vanilla. 

Dose. — Benzoin is rarely administered in substance. [15 grains (i Gm.), U. S. P.]. 

Official Preparations. 

Adeps Benzoinatus — Adipis Benzoinati — Benzoinated Lard (2 per cent.). — 
For external use. 



AROMA TIC AND FA TTY COMPOUNDS. 305 

Tinctura Benzoini — Tincturae Benzoini — Tincture of Benzoin (20 per cent.). 
— Dose, 30 minims to I fluidram (2-4 Cc.) [15 minims ( 1 Cc), U. S. P.]. 

Tinctura Benzoini Composita — Tincturae Benzoini Compositas — Compound 
Tincture of Benzoin. — Benzoin, 10; aloes, 2; storax, 8; tolu, 4; alcohol, q. s. 
parts. Dose, y 2 -2 fluidrams ^2-8 Cc. ) [30 minims (2 Cc), U. S. P.]. 

Antagonists and Incompatibles. — The tincture and compound 
tincture are incompatible with aqueous preparations, the benzoins 
and other resins and balsams being precipitated from their alcoholic 
solutions by water. 

Physiological Action. — The action of benzoin is due to the 
benzoic acid which it contains, and will therefore be considered 
under Benzoic Acid. 



Acidum Benzoicum— Acidi Benzoici— Benzoic Acid. 

77. S. JR. 

Origin. — An organic acid, C 6 H. 5 COOH, obtained from benzoin by sublimation, 
or prepared artificially. 

Description and Properties. — White or yellowish-white, lustrous scales or 
friable scales, having a slight characteristic odor resembling that of benzoin, and of a 
warm acid taste ; somewhat volatile at a moderately warm temperature, and rendered 
darker by exposure to light. Soluble, when pure, in about 281 parts of water, in 2 
parts of alcohol at about 25 C. (77° F.), in 15 parts of boiling water, and in I part of 
boiling alcohol. It is also soluble in 3 parts of ether, 7 parts of chloroform, and readily 
soluble in carbon disulphide, in benzol, and in fixed and volatile oils. Sparingly sol- 
uble in benzin. 

Benzoic acid has an acid reaction and is inflammable. It should be kept in dark 
amber-colored, well-stoppered bottles, in a cool place. 

Dose. — 5-15 grains (0.3-1 Gm.) Sj]/ 2 grains (0.5 Gm.), U. S. P.]. 

Official Salts of Benzoic Acid. 

Ammonii Benzoas — Ammonii Benzoatis — Ammonium Benzoate (U. S. P.). 
— Origin. — Dissolve benzoic acid in water of ammonia and distilled water, evaporate, 
and crystallize. It should contain not less than 98 per cent, of pure ammonium benzo- 
ate, C 6 H 5 .COONH 4 . 

Description and Properties. — Thin, white, four-sided laminar crystals; odorless, or 
having a slight odor of benzoic acid ; a saline, bitter, afterward slightly acrid taste, and 
gradually losing ammonia on exposure to air. Soluble, at 25 C. (77 F.), in 10.5 
parts of water, in 25 parts of alcohol, in 1.2 parts of boiling water, and in 7.6 parts of 
boiling alcohol. The salt is neutral or has a very slight reaction upon litmus-paper. It 
should be kept in well-stoppered bottles. 

Dose. — 10-20 grains (0.6-1.2 Gm.) [15 grains (1 Gm.), U. S. P.]. 

Lithii Benzoas — Lithii Benzoatis — Lithium Benzoate (U. S. P.). — Origin. — 
Prepared by decomposing lithium carbonate with benzoic acid. It should contain not 
less than 98.5 per cent, of pure lithium benzoate. 

Description and Properties. — A light white powder, or small, shining, crystalline 
scales ; odorless or of a faint, benzoin-like odor, and of a cooling, sweetish taste ; 
permanent in the air. Soluble in 3 parts of water, in 13 parts of alcohol, and 2.5 parts 
of boiling water, and in 10 parts of boiling alcohol. The presence of sodium benzoate 
increases the solubility in water and lessens it in alcohol. The aqueous solution (i : 
20) of lithium benzoate has a faintly acid reaction upon litmus. 

Dose. — 5-20 grains (0.3-1.2 Gm.) [15 grains (1 Gm.). U. S. P.]. 

Sodii Benzoas — Sodii Benzoatis — Sodium Benzoate (U. S. P.). — Origin. — 
Prepared by decomposing sodium carbonate with benzoic acid. It should contain not 
less than 99 per cent, of pure sodium benzoate, C 6 H 5 .COONa. 

Description and Properties. — A white amorphous powder, odorless or having a faint 
odor of benzoin, and a sweetish, astringent taste. Soluble in 1.6 parts of water, in 43 

20 



306 A TEXT-BOOK OF MATERIA MEDIC A. 

parts of alcohol at 25 C. (77 F.), in 1.3 parts of boiling water, and in 20 parts of 
boiling alcohol. The aqueous solution is neutral to litmus-paper. It is effervescent, 
and should be kept in well-stoppered bottles. 

Dose. — 5-30 grains (0.3-2 Gm. ) [15 grains (I Gm. ), U. S. P.]. 

Allied and Unofficial Preparations. 

Bismuthi Benzoas — Bismuthi Benzoatis — Benzoate of Bismuth. 

Menthol Benzoas — Menthol Benzoatis — Benzoate of Menthol. — For exter- 
nal use. 

Other benzoic combinations of interest are : Benzanilid, an antipyretic for children. 
Dose, 1-8 grains (o. I-0.5 Gm.). Benzonaphthol, analogous to betol, intestinal antisep- 
tic in doses of 4-8 grains (0.25-0.5 Gm. ). Benzosol, a guaiacol benzoate, used as an 
antiseptic and for the same general purposes as guaiacol. Dose, 4-8 grains (0.25-0.5 
Gm.). Peronin, tropococaine, saccharin, orthoform, anesthesin, and /5-eucaine are all 
benzoyl compounds. 

Antagonists and Incompatibles. — Benzoic acid is incompatible 
with the alkaline salts, as those of sodium, etc., and ammonium 
benzoate is incompatible with the ferric salts. 

Physiological Action. — Externally. — When applied in a con- 
centrated form to the skin or mucous membrane benzoic acid is an 
irritant, and produces a catarrhal condition of the bronchial mucous 
membrane when its vapors are inhaled. It is a powerful antiseptic 
and germicide, preventing the growth of putrefactive bacteria in 
a solution of 1 : 1000. 

Internally. — Digestive System. — In full medicinal doses benzoic 
acid irritates the throat and produces a sense of heat in the epi- 
gastrium. Very large doses may occasion gastric inflammation 
with nausea and vomiting. The functional activity of the liver is 
stimulated by sodium benzoate. 

Nervous System. — There is evidence to show that benzoic acid 
quiets the higher cerebral centers. 

Circidatory System. — In large doses benzoic acid increases the 
pulse-rate to a marked extent, and is a stimulant to the entire 
circulatory apparatus. Slowing follows from vagus stimulation. 

Respiratory System. — It is a powerful stimulant in moderate 
medicinal doses, increasing the respiratory movements and promo- 
ting the bronchial secretion. 

Absorption and Elimination. — It is eliminated chiefly by the 
kidneys, but also by the skin, salivary glands, and bronchopul- 
monary mucous membrane. 

An important action of benzoic acid is the change it undergoes 
in the body, being converted into hippuric acid, in combination 
with glycocoll. Some benzoic acid is eliminated unchanged, the 
hippuric acid formed renders alkaline urine acid, besides increasing 
the urinary flow and disinfecting and stimulating the genito-urinary 
tract. A copper-reducing body may also lie found in the urine. 

Temperature. — Like other members of this group, the acid, as 
well as its salts, possesses antipyretic properties, many observers 
holding it to be equal, if not superior, to salicylic acid in this 
respect. It is not yet known in what manner it reduces temper- 
ature. 



AROMATIC .AND FATTY COMPOUNDS. Z°7 

Untoward Action. — Benzoic acid sometimes produces urticaria 
or an erythematous condition of the skin. 

Therapeutics. — Externally and Locally. — The compound tinc- 
ture of benzoin is an admirable preparation for many conditions 
requiring antiseptic, astringent, and stimulating dressing. It is fre- 
quently applied to cutaneous wounds, the alcohol evaporating and 
leaving upon the injured parts a protective film of balsams. A 
piece of lint or absorbent cotton saturated with the compound 
tincture has been used to close the punctures in the skin after 
tenotomy. 

Stille recommends a combination of the compound tincture of 
benzoin and glycerin for the treatment of chapped hands and lips, 
frost-bite, fissured and chapped nipples. 

The compound tincture, diluted with water in various propor- 
tions, makes an efficient application in catarrhal affections of the 
pharynx and larynx, either in the beginning of an inflammation or 
during the relaxed condition which so often accompanies the ter- 
mination of an acute attack. The hoarse?iess of vocalists and public 
speakers, the result of excessive strain upon the vocal cords, is 
frequently relieved by this remedy, particularly as inhaled with hot 
steam. 

Inhalations of benzoin are a popular and frequently effective 
method of treating acute catarrhal inflammation of the upper 
respiratory passages. 

The cough and expectoration of chronic bronchitis and chronic 
phthisis are eased and lessened by inhaling night and morning 
I dram (4 Gm.) of benzoic acid, added to boiling water. 

A preparation like the following is an efficient and agreeable 
lotion for irritative forms of chronic nasal catarrh : 

R. Sodii boratis, ad gij (60.0 Gm.) ; 

Acidi benzoici, gr. x (0.6 Gm.). 

M. et fiat pulvis No. I, 
Sig. To half a tumblerful of water add half a teaspoonful each of the powder and 
glycerin. Use freely as a lotion. 

The simple tincture of benzoin is an excellent application to 
spongy gums. There is much evidence of the efficiency of bismuth 
benzoate as a dressing for chronic or sloughing ulcers. Specific 
sores, chancroids and chancres especially, are well treated by dust- 
ing the parts with the benzoate after throughly bathing the surface 
with a weak solution of bichloride of mercury. 

Probably the most important therapeutic action of benzoic acid 
is shown in the treatment of cystitis and pyelitis, which are com- 
plicated with decomposing and alkaline urine. 

Phosphatic calculi may be dissolved by the prolonged adminis- 
tration of ammonium benzoate, which is preferable to benzoic acid 
for this purpose. Incontinence of urine, if due simply to the alka- 
linity of the urine, is relieved by the same remedy. 

Liegeois has employed sodium benzoate as a cholagogue with 



308 A TEXT-BOOK OF MATERIA MEDICA. 

excellent results. He associates it with rhubarb. He also states 
that benzoate of sodium favorably modifies the pain of pharyngitis. 
Sodium benzoate is an excellent substitute for sodium salicylate, 
beincr especially useful in the septic diseases. It is equally power- 
ful as an antiseptic and antipyretic, though slower in its action than 
sodium salicylate. Its effects, however, are more permanent and 
innocuous. 

Administration. — Benzoic acid is best administered in pill form 
or in capsules, with balsam of fir or Castile soap as an excipient. 
The soluble benzoates may be given in solution in some aromatic 
water or in compressed pills. The solution, however, is preferable, 
and the unpleasant taste may be well disguised by a little spirit of 
chloroform. When any of these preparations are given for their 
action upon the urinary tract, it may sometimes be advantageous 
to combine them with a urinary sedative, such as tincture of bella- 
donna or hyoscyamus. 

Acidum Salicylicum— Acidi Salicylici— Salicylic 
Acid. U. S. P. 

Origin. — A monobasic organic acid (C 6 H 4 (OH)COOH 1:2) existing naturally 
in combination in various plants [like Spircza ub?iaria (meadow-sweet), Gaultheria 
procumbens (wintergreen), etc.], but chiefly prepared synthetically by combining the 
elements of pure carbolic acid with dry carbonic acid and purifying. 

Description and Properties. — Light, fine, white prismatic needles, or a 
light white crystalline powder, odorless, having a sweetish, afterward acrid taste; per- 
manent in the air. It is soluble in about 308 parts of water, in 2 parts of alcohol at 
25 C. (77 F.), and in 14 parts of boiling water. The addition of 2 parts of sodium 
sulphite or I part of ammonium phosphate renders it much more soluble in water. 

Test. — The addition of ferric chloride to a saturated solution produces a fine 
bluish-violet color. 

Dose. — 3-60 grains (0.25-4.0 Gm.) [7.5 grains (0.5 Gm.), U. S. P.]. 

Official Salts. 

Lithii Salicylas — Lithii Salicylatis — Lithium Salicylate (U. S. P.). — Origin. 
— Obtained by heating salicylic acid, lithium carbonate, and water until effervescence 
ceases, filtering, and evaporating. It should not contain less than 08.5 per cent, of 
pure lithium salicylate (C 6 H 4 (OH)COOLi). 

Description and Properties. — A white or grayish- white powder, odorless, having a 
sweetish taste, deliquescent on exposure to air, very soluble in water and alcohol. 

Dose. — 5-60 grains (0.3-4.0 Gm.") [45 grains (3 Gm.), U. S. P.]. 

Sodii Salicylas — Sodii Salicylatis —Sodium Salicylate (U. S. P.)- — Origin. — 
Prepared by acting on sodium carbonate with salicylic acid, straining, and heating the 
solution. It should contain not less than 99.5 per cent, of pure sodium salicylate 
(C 6 H t (OH)COONai. 

Description and Properties. — A white amorphous powder, odorless, sweetish, 
saline taste, permanent in air, soluble in 0.8 part of water, in 5.5 parts of alcohol at 
2 5° C. (77 F. ), and in glycerine. 

Dose.— 5.00 grains (0.3-4.0 Gm.) [15 grains (i Gm.), U. S. P.]. 
Ammonii Salicylas — Ammonii Salicylatis— Ammonium Salicylate (U. S. 
P. — D finition. — It should contain not less than 98 per cent, of pure ammonium sal- 
icylate (c,n, oiiicooxii,). 

Description and Properties. — It occurs in colorless, lustrous, monoclinic prisms or 
pi Ues, or white crystalline powder, odorless, and having at first a slightly saline, 
bitter taste, with a sweetish after taste. Permanent in dry air. The concentrated 
aqueous solution reddens blue litmus. Very soluble in water (0.9 part), slightly less 
so in alcohol (2.3 parts). 

Dose. — Average dose 4 grains (0.250 Gm. = 250 milligrammes), U. S. P. 



AROMA TIC AND FA TTY COMPOUNDS. 309 

Physiological Action. — Externally and Locally. — Salicylic acid 
is antiseptic, parasiticide, irritant to mucous membranes ; possesses 
the power to soften the epidermis ; checks perspiration when locally 
applied (anhydrotic). 

Internally.— Digestive System.— Small doses stimulate the stom- 
ach ; larger doses act as an irritant. It retards proteolysis and also 
hinders fermentation, and putrefaction in the gastro-enteric canal. 
The biliary secretion is somewhat increased, particularly as to its 
solids. The liver secretory cells are in some manner stimulated. 

Nervous System.— In small doses it has no cerebral action. In 
large doses, and in some susceptible persons in full medicinal doses, 
salicylic acid causes cerebral congestion, indicated by a feeling of 
tension in the cerebrum, headache, confusion of thought, tinnitus 
aurium, vertigo, and sometimes delirium. Toxic doses may occa- 
sionally produce cerebral convulsions. It lessens the reflexes, but 
does not affect the motor peripheral nerves. Slight analgesia may 
be produced. 

Circulatory System. — Small doses of salicylic acid have no very 
appreciable effect upon the circulation. Full medicinal doses first 
cause the heart to beat faster and stronger, increasing arterial 
tension ; later the arterial pressure is lowered, and excessive or 
toxic doses cause the pulse to become slow and labored. Its tend- 
ency ultimately, even in medicinal doses, is to depress, rather than 
stimulate, the heart. Its effect upon the blood is to restrain the 
migration of the white corpuscles. 

Absorption. — Salicylic acid is converted by the gastro-intestinal 
secretions into the sodium salicylate, in which form it enters into 
the circulation. 

Respiratory System. — Small doses stimulate the respiratory cen- 
ter and the pulmonary vagi, making the respiration quicker and 
deeper. Toxic doses paralyze the center and vagi, causing slow 
and labored respiration and death from asphyxia. 

Temperature. — Febrile temperature is markedly reduced by large 
doses of salicylic acid. The reduction takes place usually within 
half an hour after a dose has been taken, and lasts several hours. 

Elimination. — It increases the urinary flow as a direct paren- 
chyma stimulant. It appears in the urine as salicyluric acid. 

It is a powerful diaphoretic, large doses often causing exhaust- 
ing sweating. It also increases the secretion of milk and the 
amount of sugar in that secretion. 

Elimination takes place rapidly by all the emunctories (nine min- 
utes in the urine), but chiefly through the kidneys and skin. Traces 
of salicylic acid may be found for a long time after the administration 
of a single dose, ten to fifteen days, three days is the average. Met- 
abolism is markedly affected, the sulphates and nitrogen in the urine 
going up 10 per cent, under its use. Uric acid is particularly 
increased. What the mechanism is is not yet determined. 

Untoward Action. — Erythema, urticaria, or petechiae, accom- 
panied by intense itching, occasionally edema of the eyelids and 



310 A TEXT-BOOK OF MATERIA MEDICA. 

lower extremities, mental depression, muscular weakness, motor 
disturbances, sweating, and buzzing in the ears, as mentioned under 
Poisoning, but to a less degree. Occasionally bleeding is seen. 
Abortion may be induced by its use. Prolonged administration 
may also produce anemia. 

Poiso?iing. — There are roaring in the ears, deafness, intense 
headache, vertigo, and possibly delirium, profuse and exhausting 
sweating, subnormal temperature, very weak, compressible pulse, 
feeble and shallow respirations, dimness of vision, ptosis, and often 
strabismus. Albumin or blood or hemoglobin may be found in 
the urine. The urine and feces pass involuntarily. Death usually 
results from respiratory failure, but is extremely rare ; 1 5 Gm. of 
sodium salicylate has caused severe symptoms, but recovery has 
followed. 

Treatment of Poisoning. — Diffusible stimulants, atropine, strych- 
nine—the same treatment as in poisoning by acetanilid. 

Therapeutics. — Externally and Locally. — Salicylic acid has 
been satisfactorily employed, in the strength of \ to 1 dram in 1 
ounce (2-4 in 32 Gm.) of petrolatum, in the treatment of ery- 
sipelas. 

In the treatment of chancroid salicylic acid has been extensively 
employed. The powdered acid should be thoroughly dusted over 
the surface. 

The peculiar action of salicylic acid in softening and loosening 
thickened masses of epidermis and favoring the normal prolifera- 
tion of epithelium renders the drug especially useful in the treat- 
ment of indurated eczema, particularly of the palm and sole, ver- 
ruca, tylosis , callositas, corns, warts, etc. 

It is one of the most useful drugs in the treatment of forms of 
eczema, impetigo contagiosa, psoriasis, lupus, parasitic affections, and 
in 7ion-parasitic sycosis. It has been used successfully in the treat- 
ment of acne, comedones, and pruritus. A 3 per cent, solution has 
been recommended in aspergillus of the outer auditory meatus. A 
wash, 3 grains to 1 ounce (0.2 to 30 Cc.) is efficient in otorrhea. 
Solutions of varying strengths are frequently useful in acute coryza, 
diphtheria, inflammation of fauces, catarrhal stomatitis , and to cor- 
rect offensive expectoration, especially in phthisis and gangrene of 
the lung. 

Internally. — There is no better example of empiricism in thera- 
peutics than the employment of salicylic acid in acute articular 
rheumatism. Used at first in this disease to reduce temperature, 
it was found that while it exerted marked antipyretic action, it also 
lessened the pain and swelling, and in the majority of cases short- 
ened the duration of the disease. It cannot be classed as a 
" specific " in any sense of the word, but merely relieves certain 
symptoms — fever, pain, and swelling. Other symptoms — or com- 
plications, according to some authors — such as heart affections, are 
uninfluenced by this medicine. It has no power to prevent either 
affections of the heart or relapses. 



AROMA TIC AND FA TTY COMPOUNDS. 31 1 

Rheumatic tetanus, irido choroiditis, and sclerotitis are alleged to 
have been cured by this drug. It is useful in gout to relieve pain, 
but does not seem to influence the disease, and is of no particular 
value in chronic or gonorrheal rheumatism, rheumatic arthritis, or 
rJieumatic hyperpyrexia. 

It is credited with being quite efficient in chorea of rheumatic 
origin, and in relieving the pains of herpes zoster and neuralgic 
headache. 

It is a drug to be tried in many diseases of rheumatic or neu- 
ralgic character, unless some distinct contraindication to its use 
exists. It surpasses any drug, with the possible exception of 
guaiac, in the treatment of quinsy, and particularly infectious ton- 
sillitis. The medicine is highly regarded by competent advocates 
as a remedy in diphtheria. Lumbago often yields to its influence, 
and it has also been recommended in sciatica, which in the very 
mild cases is helped somewhat. 

It is a useful antizymotic to prevent putrefactive fermentation 
and flatulence, and lessen thereby the tendency to crapulous diar- 
rhea. It is of service in some cases of diabetes. 

It has been found of use in influenza, and is an efficient antisep- 
tic remedy in chronic gastric catarrh, diarrhea, cholera, and entero- 
colitis. By some eminent clinicians it is considered to be one of 
the most effectual remedies in pleurisy with effusion. 

It has been recommended as an effectual anthelmintic, both for 
tape- and round-worms. 

Contraindications. — Salicylic acid should not be given in large 
doses to persons who have a weak heart or are otherwise greatly 
debilitated, at least not without counteracting its toxic tendencies 
with nutrients and diffusible stimulants. 

Administration. — Owing to its irritant action upon the mucous 
membrane, it is best given in a solution of glycerin and some 
aromatic water, after meals. So concentrated a form as a pill or 
capsule is not recommended. 

Many of the untoward cerebral effects may be relieved by giving 
20 grains (1.3 Gm.) of sodium or potassium bromide. 

If any benefit is to be derived from salicylic acid in acute artic- 
ular rheumatism, it must be used early in the disease and in heroic 
doses at comparatively frequent intervals — not less than 20 grains 
(1.3 Gm.) every two, three, or four hours for an adult. If too 
serious gastric and cerebral symptoms manifest themselves, the drug 
may be decreased in amount or discontinued until the unpleasant 
action subsides. It is better, except in acute articular rheumatism, 
to give a small dose, repeated frequently, than to administer a full 
dose at once. 

The physiological action and therapeutics of lithium sali- 
cylate are practically the same as those of salicylic acid or sodium 
salicylate. It is, however, richer in salicylic acid than the sodium 
salt, and in gout and chronic rheumatism has been thought to be of 
more value than salicylic acid. It should be given in solution. 



312 A TEXT-BOOK OF MATERIA MEDIC A. 

Sodium salicylate is identical in physiological action and uses 
with salicylic acid, with the exception that it is less irritating to the 
stomach, and is therefore ordinarily to be preferred to the acid. 

It may be prescribed in aromatic water, in syrup, or in powder, 
pills, or capsules. 

Phenylis Salicylas— Phenylis Salicylatis— Phenyl 
Salicylate. XT. S. I>. 

(Salol, U. S. P., 1890.) 

Origin.— The salicylic ether (C 6 H 4 (OH)COOC 6 H 5 1:2) of phenyl prepared by 
heating salicylic acid with phenol in the presence of phosphorus pentachloride. 

Description and Properties. — A white, crystalline powder, odorless, or 
having a faintly aromatic odor, and almost tasteless. Permanent in the air. Almost 
soluble in 2333 parts of water ; soluble in 15 parts of alcohol at 25 C. (77 F.) ; also 
in 0.3 part of ether, and readily in chloroform and in fixed or volatile oils. 

Dose. — 3-15 grains (0.19-1.0 Gm.), [7! grains (0.5 Gm. ) U. S. P.]. 

Physiological Action. — Externally and Locally. — It is a more 
powerful antiseptic than either of its constituents. Nencki claims 
that it is not a germicide, as it will not destroy bacteria when 
present, although it prevents their formatfon. It is not, like sali- 
cylic acid, irritating to the mucous membranes. 

Internally. — It is converted by the pancreatic and intestinal 
juices into its original constituents — salicylic acid and carbolic acid. 
It is usually absorbed and eliminated very rapidly, having been 
detected in the urine in the form of salicyluric acid and phenol- 
ether-sulphuric acid within thirty minutes after its ingestion by the 
stomach. To the latter acid is due the dark, smoky color of the 
urine which sometimes exists under large or continued doses of 
salol. 

The action of salol is essentially like that of its constituents, 
but it is a more powerful antipyretic, analgesic, and cerebrospinal 
sedative. It reduces temperature much more promptly, the anti- 
pyretic action occurring within fifteen minutes after a full medicinal 
dose has been taken. The effect, however, is not prolonged, 
repeated doses being required to maintain the reduction of tem- 
perature. 

The circulation is, perhaps, not so much depressed as by sali- 
cylic acid. The respirations are at first quite rapidly increased, and 
are rendered very shallow, requiring some time to resume their 
normal condition. Large doses may cause phenol-poisoning. 

Therapeutics. — Externally and Locally. — Salol is especially 
recommended as an antiseptic dressing for wounds^ burns ^ venereal 
ulcers, and buboes. Powdered salol or an ointment — 1 part to 150 
parts of petrolatum — has been used in cases of tubercular laryngitis 
and ozena. Like salicylic acid, it is also of value in eczema and 
sycosis simplex. 

Internally. — It is an efficient remedy in all diseases benefited by 
the internal administration of salicylic acid. In addition to these 
services it is a valuable remedy in acute and chronic cystitis, gonor- 



AROMA TIC AND FA TTY COMPOUNDS. 313 

rhea, intestinal catarrh, especially duodenal catarrh and catarrhal 
jaundice, and to relieve the pains of neuritis and myalgia. 

Administration. — It may be given in pills, capsules, powders, 
emulsion, or suspended in milk. The compressed tablets of this 
drug so extensively used at present are not to be recommended, 
owing to their slow and difficult solution. 

Allied Compoimds. 

The compounds of salicylic acid are extremely numerous. It is beyond the pur- 
pose of the present volume to mention them all, but the following have been employed 
widely and have something in their favor as remedial agents : Salacetol, resembling 
salol, an acetone radicle replacing the phenyl in that compound. Used for the same 
purposes in doses of 30-45 grains (2-5 Gm.). Salicylamid 'is tasteless, more soluble 
than salicylic acid, and more active. Dose, 2-5 grains (0.1-0.3 Gm. ). Salifebrin, 
acetanilid and salicylic acid ; not reliable. Saligenin, a substitute for salicin in doses 
of 8-15 grains (0.5-1 Gm.). Salipyrine, antipyrine and salicylic acid, has the com- 
bined effects of its constituents, and is an efficient drug in doses of 15-30 grains (1-2 
Gm. ). Salophen, resembling salol somewhat, but phenol in different form, acetyl 
/-amidophenol. Dose, 12—30 grains (1-2 Gm.). Aspirin, acetyl salicylic acid, is not 
irritating to the intestines. Dose, 30-40 gr. (2-3 Gm.). 

It should be recalled that practically all of these derivatives are decomposed to 
salicylic acid and to sodium salicylate. 

Salicinum— Salicini— Salicin U, S. P. 

Origin. — Aglycosid obtained from several species of Salix (willow) and Populus 
(poplar). 

Description and Properties. — Colorless or white, silky, shining, crystalline 
needles, or a crystalline powder, odorless and having a very bitter taste. Permanent in 
the air. Soluble in 21 parts of water, 71 parts of alcohol at 25 C. (77 F. ), 0.7 part 
of boiling water, and in 2 parts of boiling alcohol. 

Dose. — 10 grains-2 drams (0.6-8.0 Gm.) [15 grains (i Gm. ), U. S. P.]. 

Physiological Action. — Its physiological effect is analogous to 
that of salicylic acid, but is much less active than the latter. It 
does not disturb digestion, but in moderate doses promotes appe- 
tite and acts like other bitters. It is more rapidly absorbed than 
salicylic acid, is partly decomposed, and is found in the urine, as 
salicin and salicylic acid, in from fifteen to thirty minutes after the 
ingestion of a single dose. 

Therapeutics. — While inferior to salicylic acid in most respects, 
salicin is frequently used for the same purposes. 

Administration. — Salicin may be administered in powders, 
capsules, or solution. Owing, however, to its bulk and intensely 
bitter taste, it is perhaps best given in suspension in the aromatic 
elixir of licorice or in syrup of yerba santa. 

Oleum Gaultheriae— Olei Gaultheriae— Oil of 
Wintergreen. U. S. JP. 

Origin. — A volatile oil distilled from the leaves of Gaultkeria procumbens L., a 
small evergreen plant indigenous in the northern hemisphere and bearing a scarlet, 
fleshy, berry-like fruit. 

Description and Properties. — The volatile oil is a colorless or yellow, or 
occasionally reddish, liquid, having a characteristic, strongly aromatic odor, and a 
sweetish, warm, and aromatic taste. Specific gravity, 1.172 to 1.180 at 25 C. (77 F.). 



314 A TEXT-BOOK OF MATERIA MEDICA. 

It consists almost entirely of methyl salicylate. It should be kept in well-stop- 
pered bottles, protected from light. 

Dose. — 2-10 minims (0.12-0.6 Cc.) [15 minims (1 Cc), U. S. P.]. 

Official Preparation. 

Spiritus Gaultherise — Spiritus Gaultheriae — Spirit of Gaultheria (Essence 
of Wintergreen). — Dose, 1-2 fluidrams (4.0-8.0 Cc.) [30 minims (2 Cc), 
U. S. P.]. 

Physiological Action. — Externally and Locally. — Oil of winter- 
green is a stimulant and a powerful antiseptic. 

Internally. — Its action is identical with that of salicylic acid and 
its salts. 

Therapeutics. — Externally and Locally. — Used for the same 
purposes as the aromatic oils, and also locally applied in the treat- 
ment of acute articular rheumatism. 

Internally. — Used for the same purposes as salicylic acid. 

Methylis Salicylas— Methylis Salicylatis— Methyl 
Salicylate. 77. 8. P. 

Definition.— An ester (C 6 H 4 (OH)COOCH 3 1:3) produced synthetically. It is 
the principal constituent of oil of gaultheria and oil of betula. 
Dose. — 15 minims (1 Cc), U. S. P. 

Oleum Betulae— Olei Betulae— Oil of Birch. 
U. S. P. 

Definition. — A volatile oil obtained by maceration and distillation from the bark 
of the sweet birch, Betula lenta L. 

Dose. — 15 minims (1 Cc), U. S. P. 

Allied Compounds. 

Aspirin, acetyl salicylic acid, is decomposed in salicylic acid in the intestines, and 
hence has no marked advantage. Its taste is less offensive and hence it can be taken 
by patients who have irritable stomachs. 30-45 grains (2-3 Gm.). 

Mesotan is a methyloxymethyl ester of salicylic acid. It is a liquid and resem- 
bles oil of wintergreen without its agreeable (?) odor. It is readily absorbed by the 
skin and is thought to influence the joints more promptly than the oil of wintergreen. 
It is of value in lumbago also, and may be combined with olive oil and massage in 
some of the more protracted arthritides. It has the same indications as the other sal- 
icylates, and taken internally is ultimately broken down into sodium salicylate. 

Liquor Formaldehydi— Liquoris Formaldehydi— 
Solution of Formaldehyde. U. S. JP. 

Definition. — An aqueous solution containing not less than 37 per cent, by 
weight of absolute formaldehyde, H.COII. 

Properties. — Formaldehyde itself is a gas at ordinary temperatures, having a 
very pungent odor. The various products on the market are solutions of the gas in 
water. They are variously known as formalin, formol, met/iylaldehyde, oxymethylene, 
methanal, etc. Formaldehyde readily undergoes polymerization, whereby a solid form 
is obtained, known as paraformaldehyde, ox para form. When a solution of formalde- 
hyde is evaporated by heat, and more slowly by long standing, paraformaldehyde 
separates as a white, flocculent, nearly odorless mass, which is almost insoluble in 



AROMA TIC ACIDS. 315 

water, alcohol, or ether, and which begins to sublime below ioo° C. When heated, 
paraformaldehyde vaporizes and reforms the gaseous formaldehyde. It is sold in 
tablets which are employed for disinfecting purposes by vaporization. 

Formaldehyde is very active chemically ; it has a strong reducing action and 
unites with ammonia, forming the official odorless hexamethylenamine (urotropine). 
It is easily oxidized. 

Several dusting-powders containing formaldehyde in combination have been 
introduced ; thus glutol is a compound of gelatin and formaldehyde, amyloform, of 
starch and formaldehyde, etc. 

Formaldehyde is a constituent of many food-preservatives, embalming prepara- 
tions, etc. 

Therapeutics. — Formaldehyde solutions are efficient and valu- 
able bactericides. They are used very extensively in mouth- 
washes, etc. The vapor and liquid are very irritating and are not 
well adapted to internal medication. 



VOLATILE OILS, RESINS, OLEORESINS, BALSAMS. 



The following-named drugs, classed by some authors as aro- 
matics, are not only active antiseptics and antispasmodics, but 
possess properties very similar to those of the more typical anti- 
septics, antipyretics, and anesthetics. These antiseptic properties 
of aromatic drugs are well known to modern science, and, what is 
of unique interest and significance, were perfectly familiar to the 
ancients, who could not possibly divine the scientific value of the 
virtues familiarized only by the crudest empiricism. In the custom 
of the Egyptians of embalming the dead we have a remarkable 
example of their divination of antisepsis in the perfumes and spices 
in which their dead were buried ; and in the Christian Gospel we 
read of Nicodemus that he " brought a mixture of myrrh and 
aloes," and that " they took the body of Jesus, and wound it in 
linen cloths with the spices, as the manner of the Jews is to bury " 
(John xix. 39, 40). 

Aromatics owe their virtues chiefly to the volatile oils they con- 
tain, which usually possess the characteristic odor and taste of the 
plants from which they are derived. These volatile oils are very 
numerous and extremely complex in their chemical structure, yet 
most have certain general features in common. The most widely 
distributed chemical constituents are terpenes, hydrocarbons of the 
aromatic series (C 5 H 8 ) n . Many of them contain, in addition, 
phenols, aldehydes, ketones, alcohols, acids, esters, lactones, and 
oxides — a few contain nitrogen or sulphur, in which case their 
action is the more complex. 

The chemical investigation of many of these oils has but just 
begun, and it is not improbable that in the isolation and purifica- 
tion of some of their constituents valuable therapeutic agents may 
be added to the physician's armamentarium. As they agree in 
their physiological action, in large part at least, the general effects 
are here summarized in brief. It should be remembered that 
many of these volatile oils are very widely employed in alcoholic 
liquors — creme de mentJic, curagoa y maraschino^ absinthe, kiunmel, 
chartreuse, etc., and therein add their effects to those of the 
alcohol. 

General Action. — Locally, the volatile oils are stimulant and 
irritant. Internally, when taken in moderate quantities, they stimu- 
late the digestive organs, and increase the activity of the circula- 
3 1 



VOLATILE OILS, RESINS, OLEORESINS, BALSAMS. 317 

tion reflexly by stimulating the sensory ends of the vagus distrib- 
uted to the mucous membrane of the stomach. The impression is 
conveyed to the center in the medulla, and from there transmitted 
to the accelerator nerves of the heart. Very large doses depress 
the heart's action, arresting it in diastole. The poisonous action 
of aromatics is similar to that of irritant narcotic poisons. The 
different oils will vary considerably according to the predominant 
constituent. Thus the purer terpenes containing oils are much less 
poisonous ; while those containing- phenols, as eugenol, thymol, 
etc., give the characteristic picture of carbolic acid poisoning. Most 
of them irritate the kidneys. Many of them are quite powerful local 
anesthetics, particularly if rich in ketones or phenols. They first 
stimulate, and then depress and exhaust, the nervous system. In 
diseased conditions they are used to increase peristalsis, to impart 
tone to the stomach, and to act as antiseptics ; to arrest gastric and 
intestinal fermentation ; to relieve pain wherever they are applied ; 
and, by increasing the circulation in the brain and improving the 
condition of the gastro-intestinal tract, to relieve many of the phe- 
nomena of hysteria. The chief contraindication for the internal 
use of these drugs is the inflammation of the stomach, intestines, 
and kidneys. 

The volatile oils and the various preparations of the aromatics 
should be given diluted in some proper vehicle. 

A classification of this general group is not feasible. The indi- 
vidual members are so complex that a purely chemical classifica- 
tion, based on their many constituents, would be impractical. 
From the purely physical standpoint they may be divided into a 
few broad groups, as volatile oils, resins, oleoresins, gumresins and 
balsams, but this offers no clue to their therapeutic applications. 
The definitions of these groups may be found in another place in 
this book. The general grouping arrangement by many of the older 
writers on materia medica commends itself as practical, and the 
following series will be taken up : (1) Skin irritants and counter- 
irritants, including turpentine and its allies, mustard and canthar- 
ides ; (2) aromatic flavoring vehicles and carminatives, including 
mentha, coriandrum, anthemus, matricaria, anisum, marrubium, 
rosa, aurantium, caryophyllus, cardamomum, cinnamomum, fcenic- 
ulum, myristica, carum, and a number of others ; (3) condiments : 
piper, capsicum, zingiber, macis, etc. ; (4) stimulants to the respira- 
tory and genito-urinary mucous membranes ; and (5) volatile oils 
used as nervous stimulants. 

It should be borne in mind, in view of their composition, that 
any or all of them may be used as antiseptics, and, further, that some 
members of the group may be classed in any or all of the groups 
mentioned. Thus capsicum is a good counterirritant, an excellent 
aromatic carminative, a widely employed condiment, and may be 
of service in the late period of a chronic cystitis ; others might be 
instanced. Thus the classification is purely convenient — it pos- 
sesses no other value. 



318 A TEXT-BOOK OF MATERIA MEDICA. 

L IRRITANTS AND COUNTERIRRITANTS, 

These are drugs which excite more or less local irritation 
when applied to the skin ; the inflammatory condition is accom- 
panied by an effusion of serum between the epidermis and dermis — 
i. e., a blister. 

The principal vesicants are : 

Acetic acid (glacial), Mezereon, 

Ammonia (the confined vapor), Mustard (volatile oil), 

Cantharides, Rhus Toxicodendron. 
Iodine, 

There are certain drugs which affect certain parts of the skin — 
for instance, the orifices of the sudoriferous glands — in a special 
manner, and their action on these parts is such as to give rise to 
pustules rather than blisters. Drugs which affect the skin in this 
manner are called Pustulants. The following-named drugs are 
the most important of them : 

Croton oil, Silver nitrate, 

Tartar emetic, Ipecac. 

Therapeutics. — Vesicants are employed as local stimulants in 
chronic ulcers and to facilitate the absorption of effusions, as in 
chronic synovitis or chronic thickening about the joints. 

Blisters are also of use in endocarditis, neuralgias, sciatica, chronic 
pericarditis, pleurisy, hysterical paralysis, and aphonia, cerebral or 
spinal meningitis, etc. 

Pustulants are more particularly employed to maintain a con- 
tinuous though moderate irritation in chronic inflammations. They 
are but rarely used for the same class of cases as vesicants, but are 
preferable when it is desirable to prolong the local irritation with- 
out exciting too much inflammation. 

Contraindications. — Vesicants are usually contraindicated in 
acute inflammations and in inflammation of the cutaneous tissues, 
as rubeola and scarlatina. Vesicants are not permissible in preg- 
nancy, debility, scorbutus, and purpura, or in extreme infancy and 
old age. They should not be applied over the scrotum or the 
mammary glands, nor over bony prominences where the healing 
processes are apt to be retarded. 

Cantharis— Cantharidis— Cantharides. 77. S. -P. 

(Spanish Flies.) 

Origin. — Cantharis vcsicatoria De Geer, a beetle indigenous to Southern and 
Central Europe, and found eastward as far as Western Asia. It should be thoroughly 
dried at a temperature not exceeding 40 C. ( 104 F. ). 

Description and Properties. — About 1 inch (25 Mm.) long and % inch (6 
Mm. 1 broad ; flattish-cylindrical, with filiform antenna?, black in the upper part, and 
with long wing-ca-es and ample, membranous, transparent, brownish wings, elsewhere 
of a shining, coppery-green color. The powder is grayish brown, and contains green 
shining particles. Odor strong and disagreeable ; taste slight, afterward acrid. 



IRRITANTS AND COUNTERIRRITANTS. 319 

Cantharides contains a fatty crystallizable body, cantharidin, supposedly related to 
benzol, which is the active principle, a volatile oil also possessing vesicatory properties, 
and a green oil closely allied to chlorophyl. Cantharidin is found in a number of 
beetles. 

Used externally. 

Dose. — 1 / 2 grain (0.03 Gm.), U. S. P. 

Official Preparations. 

Ceratum Cantharidis — Cerati Cantharidis — Cantharides Cerate. — Canthar- 
ides, 320; yellow wax, 180; resin, 180; lard, 170; liquid petrolatum, 150. Used 
externally. 

Collodium Cantharidatum — Collodii Cantharidati— Cantharideal Collodion 
(Blistering Collodion). — Used externally. 

Tinctura Cantharidis — Tincturae Cantharidis (60 per cent.) — Tincture of 
Cantharides. — Dose, 1-5 minims (0.06-0.3 Cc.) [5 minims (0.3 Cc), U. S. P.]. 

The cantharides cerate is an ingredient of Emplastrum Picis Cantharidatum. 

Physiological Action. — Externally and Locally. — Cantharides 
is a slow though very powerful irritant. When the drug is applied 
to the skin or mucous membrane it excites a tingling, burning pain, 
with marked redness of the cuticle. In the course of three or four 
hours after the application of cantharides there are formed numer- 
ous vesicles which soon coalesce, forming one large bleb full of 
clear serum. 

The drug not only causes vascular dilatation of the part to 
which it is applied, but reflexly dilates the blood-vessels of the 
deep-seated organs underneath, thus acting as a counterirritant. 

The active principle of cantharides may be absorbed through 
the skin, producing its constitutional effects. 

Internally. — Digestive System. — Moderate doses of cantharides 
produce a sensation of heat in the stomach, and may even occasion 
gastrodynia. Large amounts occasion severe gastro-intestinal irri- 
tation. There is a sense of constriction in the esophagus, a burning 
heat in the throat, ptyalism, intense gastric pain, nausea, and vomit- 
ing of glairy mucus often containing blood. There is great tender- 
ness over the abdomen, fibrinous and sometimes bloody stools, 
attended by griping pain and tenesmus. 

Nervous System. — Small doses have no influence on the nervous 
system other than would be produced by stimulation of the 
circulation. Excessive amounts have produced marked cerebral 
effects, consisting of partial or general convulsions, coma, and 
insensibility. 

Circulatory System. — Full medicinal doses excite the heart, 
increasing the force and rapidity of its action, and elevate arterial 
tension. Under large doses the pulse and arterial pressure fall, 
and there is great depression of the entire circulatory system. 

Respiratory System. — No effect follows medicinal doses ; toxic 
amounts accelerate and weaken the respiration. 

Absorption and Elimination. — The active principle of cantharides 
is rapidly absorbed; as it is eliminated, produces marked irritation 
of the genito-urinary organs. There is at first increase of urine, 
which is soon greatly diminished in amount, and which may be 



320 A TEXT-BOOK OF MA TERIA MEDICA. 

albuminous or bloody. There is strangury and frequent desire to 
micturate, and severe pain in the loins and bladder. The local irri- 
tation is apt to occasion priapism, with frequently erotic excitement 
and seminal emissions. There may also be swelling and inflamma- 
tion of the external genitals. In women cantharides may also 
occasion increased sexual desire, cause abortion, or induce men- 
struation. Yet amatory desire does not always follow the ingestion 
of cantharides, even in large doses. Indeed, the aphrodisiac effect 
of the drug is usually more manifest under small or full medicinal 
doses than from the ingestion of immoderate amounts. The drug 
is principally eliminated by the kidneys. 

Temperature. — The temperature is at first elevated by excessive 
amounts, but declines together with the depression of the circu- 
latory system. 

Uterus. — The uterus and female genital organs are stimulated by 
the drug, as has been previously described. 

Untoward Action. — The untoward manifestations do not differ 
from the symptoms produced by excessive amounts, as described 
under the different systems. These various untoward effects vary 
in intensity according to the individuality of the patient. 

Poisoning. — Toxic amounts of cantharides produce violent gastro- 
intestinal and genito-urinary inflammation. The general symptoms 
are great pain in the throat, stomach, and bowels, excessive thirst, 
vomiting of bloody mucus, frequent stools which may contain blood, 
burning pain in the kidneys, strangury, scanty, albuminous, and 
bloody urine, painful erections of the penis, seminal emissions, swell- 
ing and inflammation of the external genitals, a rapid, small, and 
weak pulse, accelerated respiration, skin hot and dry, congestion of 
the face, pain in the head, delirium, trembling, partial or general 
convulsions, and coma. The postmortem appearances are swell- 
ing, ecchymoses, and sometimes gangrene of the mucous mem- 
brane of the alimentary canal. The kidneys are enlarged and 
engorged, and are in a condition of parenchymatous and desquam- 
ative nephritis. 

Treatment of Poisoning. — The stomach should be emptied, and 
demulcents, stimulants, and opiates given as necessary. Oils and 
fats should be avoided, as they increase the solubility and favor the 
absorption of cantharidin. 

Therapeutics. — Externally aiid Locally. — A cantharidal blis- 
ter is frequently of service as a revulsive when there is a local tend- 
ency to congestion. The drug is applied to the chest in the second 
stage of pneumonia and in pleurisy \ and " flying " blisters are 
beneficial in hydrothorax and chronic pleurisy. 

The cure of boils and carbuncles has been hastened by applying 
a cantharidal blister to the indurated spot. 

The drug is also of service to stimulate indolent ulcers, fistula, 
etc. 

A blister over the region of the heart will often afford marked 
relief in pericarditis. 



IRRITANTS AND COUNTERIRRITANTS. 321 

A cantharidal plaster applied over the course of the affected 
nerve frequently affords great relief from pain in neuralgia and 
some forms of sciatica. 

In subacute or chronic inflammatory diseases of the brain and 
spinal cord, such as meningitis, blisters applied to the nape of the 
neck or along the course of the cord, a little to one side of the 
vertebrae, will often favorably influence the course of the disease. 

Blisters are frequently of service in synovitis and periostitis of 
the larger bones. A blister applied to the epigastrium will some- 
times allay gastric pain and obstinate vomiting. 

Blistering over the region of the ovary is an efficient means of 
relieving the symptoms of chronic ovaritis, and a blister applied to 
the mastoid region will frequently be of benefit in otitis media. 

Small patches of tinea tonsuraiis and of tinea circinata may be 
removed by blistering. 

Liniments and lotions containing tincture of cantharides are 
among the best means of curing alopecia. 

Internally. — Certain diseases of the genito-urinary organs, as 
debility of the bladder with accompanying inconti?ie7ice of urine, 
chronic pyelitis, chronic catarrh of the bladder, etc., are benefited 
by small doses of tincture of cantharides. 

Gleet, prostatorrhea, and spermatorrhea are benefited by this 
drug. Menorrhagia and amenorrhea occurring in debilitated women 
will often be benefited by cantharides. 

Tincture of cantharides, with tincture of iron, tincture of nux 
vomica, and phosphoric acid, is a useful combination in impotence, 
the result of old age, sexual excesses, or masturbation. 

In scaly skin diseases cantharides often proves very serviceable 
after arsenic and the external application of tarry preparations have 
failed. 

Administration. — A cantharidal blister should not be allowed 
to remain on the skin for more than twelve or twenty-four hours, 
six to eight hours usually being sufficient. Care should be taken 
of the blisters, as they are apt to be infected very readily. 

The obstinate ulcers which sometimes follow the use of can- 
tharides blisters may be treated effectively by Goulard's cerate. 

For internal use the tincture of cantharides is the only prepara- 
tion to employ. 

Sinapis Alba-Sinapis Albas— White Mustard. 

U. S. P. 

Origin. — The seed of Sinapis alba L. 
Dose.— 120 grains (8 Gm.), U. S. P. 

Sinapis Nigra— Sinapis Nigrae— Black Mustard. 

U. S. JP. 

Origin. — The seed of Brassica nio-ra (L.) Koch. 

Both the white and black mustard are annual plants, indigenous in Southern Europe 
and Western Asia, cultivated, and sometimes found wild in the United States. 
21 



322 A TEXT-BOOK OF MATERIA MEDICA. 

Description and Properties. — White mustard seeds are almost globular, 
about Jj inch (2 Mm.) in diameter, with a circular hilum; testa yellowish, finely pitted, 
hard; embryo oily, with a curved radicle and two cotyledons, one folded over the 
other ; free from starch; inodorous ; taste pungent and acrid. 

Black mustard seeds resemble the preceding in shape, but have a diameter only 
of 2V mcn i l Mm.) ; blackish-brown or deep reddish-brown, with a testa covered with 
shallow pits, and when crushed and macerated with water acquiring a strong and pun- 
gent odor. 

White mustard seeds contain an almost tasteless, yellowish, fixed oil, and a 
glycoside known as sinalbin, which is the chief constituent. This substance may be 
converted into sulphocyanate of acrinyl (the volatile oil of mustard) by the action of 
the ferment myrosin and water : 

Sinalbin. Volatile Oil. 



Black mustard seeds contain the same fixed oil as the white mustard, and a 
glycoside, sinigrin, which by the action upon it of myrosin in contact with water con- 
verts it into allyl isosulphocyanate (a volatile oil): 

Sinigrin. Volatile Oil. 

C 10 H 18 KNS 2 O, =CSN0 3 H 5 + C 6 H 12 6 + KHS0 4 

To this volatile oil of mustard, which is official, are due both the pungent taste and 
odor of the moistened powder. 

Dose. — 1-4 drams (4.0-15.0 Gm.) [120 grains (8.0 Gm.), U. S. P.]. 

Official Preparation (of Black Mustard Seed). 

Charta Sinapis — Chartae Sinapis — Mustard Paper. 

Oleum Sinapis Volatile— Olei Sinapis Volatilis— 
Volatile Oil of Mustard. U. S. JR. 

Origin. — A volatile oil obtained from black mustard by maceration with water 
and subsequent distillation, yielding not less than 92 per cent, of allyl isothiocyanate. 

Description and Properties. — A colorless or pale-yellow, limpid, and 
strongly refractive liquid, having a very pungent and acrid odor and taste. Freely 
soluble in alcohol, ether, or carbon disulphide. Used externally. 

Physiological Action. — Externally and Locally. — Mustard is 
irritant, counterirritant, rubefacient, and vesicant. Any degree of 
irritation, from slight redness of the skin to severe blistering, may 
be produced by mustard. It is more rapid in its action than can- 
tharides, and when applied to the skin there is produced almost 
immediately a sensation of warmth, which rapidly passes into a 
severe burning pain. This irritation of the sensory nerves is suc- 
ceeded by paralysis and more or less loss of sensation, so that if 
mustard be allowed to remain on the skin until blistering ensues 
there is a decided diminution of pain. 

The local application of mustard reflexly stimulates the heart 
and respiration. 

Internally. — Mustard in small amounts is taken as a condiment, 
and is a powerful stimulant of the gastro-intestinal tract. Large 
doses irritate the stomach and act as an emetic, producing prompt 
emesis without depression, owing to the reflex stimulation of the 
heart and respiration. 



IRRITANTS AND COUNTERIRRITANTS. 323 

The volatile oil of mustard is never intentionally given inter- 
nally. It is a powerful caustic irritant, a single drop upon the 
tongue producing an intense burning pain in the throat, stomach, 
and nose. 

Therapeutics. — Externally and Locally. — Mustard may be used 
locally for the same purposes as cantharides, being superior to the 
latter-named drug when a simple rubefacient effect is desired. 
Mustard when applied locally is more of a stimulant to the circu- 
latory and respiratory systems than cantharides, and is therefore an 
efficient remedy in syncope, asphyxia, and coma. 

As a stimulant in these conditions, a large mustard poultice is 
applied to the legs. 

A mustard bath, in the strength of 1 dram (4.0 Gm.) to 1 
gallon (3785.43 Cc.) of water, is an efficient means of breaking up 
a cold, and if properly used is of service when the rash in measles 
or scarlet fever has receded. 

The menses may often be re-established when suppressed by a 
mustard sitz-bath, taken at the time of the expected period. 

Internally. — Other than the use of mustard as a condiment, the 
drug is given only to produce vomiting, being one of the best 
emetics in indigestion and narcotic poisoning. 

Obstinate hiccough has sometimes been arrested by an infusion 

OF MUSTARD. 

Administration. — A mustard plaster, or sinapism, is prepared 
by mixing equal parts of wheaten or rye flour with water to the 
consistence of a thick paste, which is spread on linen or cotton 
cloth and applied to the skin. A dampened piece of gauze inter- 
posed between the plaster and the skin will prevent the former 
from adhering. 

A mustard cataplasm is a weaker preparation. A flaxseed or 
cornmeal poultice is made, to which a small quantity of ground 
mustard is added. This is intended to maintain a gentler but more 
prolonged action than the sinapism. 

" Mustard leaves," or plasters which may be obtained ready pre- 
pared at drug stores, are intended to be simply dipped in water and 
applied to the skin. Their activity may be lessened by interposing 
a thin piece of linen or cotton cloth between the plaster and the 
skin. 

Liniments containing oil of mustard are efficient rubefacients, 
care being taken to adapt the strength of the preparation to the 
delicacy of the skin. 

When mustard is taken as an emetic it is given in the form of 
an infusion, in the proportion of I, 2, or 3 drams (4.0, 8.0, or 
12.0 Gm.) to I pint (473.17 Cc.) of water. 

A preparation known as mustard whey is sometimes given. It 
is prepared by boiling 1 J ounces (46.65 Gm.) of bruised mustard 
seed in a mixture of 1 pint (473.17 Cc.) of milk and 1 quart 
(946.35 Cc.) of water, until it is curdled, when the whey should 
be strained off. 



324 A TEXT-BOOK OF MA TERIA MEDICA. 

Allied Products. 

Thiosinamine, a product from the volatile oil of mustard, is a useful drug for 
keloid and scar tissue. It is used in 10-20 per cent, strength as an injection or local 
application. 

Oleum Terebinthinae— Olei Terebinthinae— Oil of 
Turpentine. U. S. P. 

Origin.— A volatile oil recently distilled from turpentine — a concrete oleoresin 
obtained from Pinus palustri% Miller and other species of Pinus. 

Description and Properties. — A thin, colorless liquid, of a characteristic 
odor and taste, both of which become stronger and less agreeable with age and exposure 
to air. Soluble in three times its volume of alcohol. Oil of turpentine should be kept 
in well-stoppered bottles, protected from light. 

Dose. — 5-15 minims (0.3-1.0 Cc), in emulsion. 

Official Preparations. 

Emulsum Olei Terebinthinae — Emulsi Olei Terebinthine — Emulsion of 
Oil of Turpentine. — Definition. — A 15 per cent, (by volume) emulsion of rectified oil 
of turpentine, containing 5 per cent, (by volume) of expressed oil of almond. Dose. — 
Average dose: I fluidram (4 Cc. ), (U. S. P.) One fiuidram contains about 9 minims 
of oil of turpentine. 

Linimentum Terebinthinae — Linimenti Terebinthinae — Turpentine Lini- 
ment (35 per cent, with resin cerate). For external use. 

Oleum Terebinthinae Rectificatum — Olei Terebinthinae Rectificati — Rec- 
tified Oil of Turpentine. — Dose, 5-15 minims (0.3-1.0 Cc.) [15 minims (iCc), 
U. S. P.J. 

Physiological Action. — Externally and Locally. — When applied 
to the epidermis the drug dilates the cutaneous blood-vessels, occa- 
sioning a sensation of heat and producing redness of the skin, and, 
if the oil be applied with inunction for any length of time, vesica- 
tion ensues, with, occasionally, intractable ulcerations. The fumes 
of oil of turpentine when inhaled cause great irritation of the eyes 
and the respiratory passages. 

The drug is readily absorbed from the unbroken skin. 

Internally. — Digestive System. — When taken into the mouth 
turpentine produces a burning, pungent taste and an immediate and 
augmented salivary secretion. Swallowed in immoderate amounts, 
the drug occasions a sensation of heat in the epigastrium, with in- 
creased peristaltic action and secretion. The intestines are simi- 
larly affected, the intestinal peristalsis being greatly augmented, the 
drug acting as an efficient carminative. 

Large doses of turpentine produce severe burning pain in the 
stomach and bowels, accompanied by nausea, vomiting, and purg- 
ing, the feces often containing blood. 

The drug is an efficient anthelmintic for tapeworm. 

Nci'vous System. — Small doses increase and large doses dimin- 
ish reflex excitability. Large doses produce giddiness, mental 
exhilaration, and incoherence of ideas, followed by dulncss and 
occasional coma. 

There is incoordination of movements, resulting in unsteady 
gait, great muscular weakness, and diminished sensation, usually 
preceding the impairment of voluntary motion. 



IRRITANTS AND COUNTER IRRITANTS. 325 

Circulatory System. — Turpentine is a cardiac stimulant, increasing 
the force and rapidity of the heart's action and raising arterial ten- 
sion by direct cardiac influence. The blood-vessels are contracted 
by the drug, which may account for its hemostatic properties. 
Very large doses slow the heart by stimulating the vagus inhibitory 
center. 

Respiratory System. — The effect of inhaled oil of turpentine on 
the respiratory passages has been described. When ingested the 
drug increases and disinfects the bronchial secretion. Small doses 
increase and large doses diminish the respiratory movements. 

Absorption and Elimination. — Oil of turpentine is rapidly diffused 
in the blood, in moderate doses stimulating the kidneys and in- 
creasing the flow of urine, to which it imparts the odor of violets. 
Large doses irritate the kidneys, lessening the amount of urine, 
rendering it highly colored, and in some cases producing albu- 
minuria, hematuria, and even total suppression. There are present 
priapism and a frequent desire to micturate. 

Turpentine is rapidly eliminated from the system, not only by 
the kidneys, but by the skin, and bronchial and intestinal mucous 
membranes as well. 

Temperature. — The drug is a mild antipyretic. 

Untoward Action. — Erythema and eczematous eruptions are 
produced by both the ingestion and the local application of turpen- 
tine. In susceptible individuals small doses may occasion serious 
disturbances of the genito- urinary and gastro-intestinal tracts, such 
as strangury, painful erections, salivation, and stomatitis. 

The administration of repeated doses of oil of turpentine may 
produce peculiar nervous manifestations, such as headache, drowsi- 
ness, dizziness, and a sense of mental vacuity. 

Poisoning. — Few cases are recorded of death resulting from the 
ingestion of excessive amounts of turpentine, owing to the fact 
that the greater amount of the drug is eliminated by the intestines. 

The symptoms produced by very large doses are — great mus- 
cular weakness, abolition of reflexes, and violent vomiting and 
purging, with bloody evacuations from the bowels. There is great 
irritation of the genito-urinary tract, with constant efforts to mic- 
turate, hematuria or entire suppression of urine, painful priapism, 
and violent strangury. 

The skin is moist and the face flushed or cyanosed, while dila- 
tation of the pupils, slow, labored and stertorous breathing, and 
occasionally paroxysms of convulsive coughing, may be attendant 
symptoms. Convulsions may occur. Icterus has been noted. 

Either great mental excitement or profound insensibility may be 
present. The heart and circulatory system are greatly depressed, 
death, when occurring, being usually the result of cardiac failure. 
15 Gm. has been deadly for a child, and 120 Gm. has been taken 
by an adult without a fatal result. 

A form of chronic poisoning frequently is seen among those 
who work with turpentine, such as painters, etc. ; sleepiness, heavi- 



326 A TEXT-BOOK OF MATERIA MEDIC A. 

ness, easily tired, and great muscular heaviness are frequent symp- 
toms. Insomnia, irritable heart action, acne, and general malaise 
are other common symptoms. 

Treatment of Acute Poisoning. — The stomach should be at once 
evacuated, and elimination favored by every possible means. The 
free administration of demulcent drinks is advisable, while to relieve 
pain, opium may be given. Other symptoms should be treated 
according to their indications. 

Therapeutics. — Externally and Locally. — Oil of turpentine is 
an efficient counterirritant, being employed as such in lumbago, my- 
algia, neuralgia, rheumatic pains, bronchitis, pleurisy, and various 
forms of chronic inflammation. A turpentine stupe is perhaps the 
most effective method in the local application of the drug. It is 
applied as follows: (i) A flannel is wrung out of hot water, 
sprinkled well with the oil, and allowed to remain in contact with 
the affected part for from five to twenty minutes, as indicated by the 
sensibility of the skin. Care must be taken in the preparation of 
the flannel lest the patient be chilled or scalded. (2) A vessel 
containing the oil is placed in hot water and a flannel wrung from 
the oil applied as desired. 

A turpentine stupe is perhaps the most grateful and efficient 
local application in peritonitis. 

Owing to its antiseptic and hemostatic properties the oil of 
turpentine is frequently and beneficially employed as a dressing 
for lacerated wounds. 

The drug is an active parasiticide, and has been used success- 
fully in the treatment of tinea tonsurans, etc. It has also been 
favorably recommended, when diluted with some bland oil, as a 
remedy for alopecia areata and psoriasis. 

Turpentine serves a useful purpose in many diseases of the ear 
and throat. 

J. Solis Cohen recommends the vapor of turpentine as an 
efficient means of allaying the cough and irntation occasioned by 
acute laryngeal catarrh. 

The inhalation of the oil of turpentine lessens pulmonary 
hyperemia and excessive bronchial secretion. 

' / Internally. — Turpentine is a valuable remedy for gastric or 
intestinal flatulence t particularly when the condition arises from an 
atonic state of the muscles of the stomach or intestines. 

The drug is frequently employed in typhoid fever, not only for 
the relief of tympanitis, but also to check intestinal hemorrhage. 

In chronic intestinal catarrli, as well as in a catarrhal condition 
of any mucous membrane, turpentine is a valuable remedial agent. 

Turpentine is a very powerful anthelmintic against tapeworm. 
When given for this purpose it should be administered in a single 
large dose, from 4-8 fluidrams (15.0-30.0 Cc), together with a large 
dose of some purgative like castor oil to ensure the prompt elim- 
ination of the turpentine from the bowels. 

As has been suggested, the drug has a decided and beneficial 



IRRITANTS AND COUNTERIRRITANTS. 2> 2 7 

influence upon relaxed and chronic catarrhal conditions of mucous 
membranes, rendering this remedy of great value in bronchorrhea, 
chronic bronchitis, emphysema with marked bronchial catarrh, etc. 
This action upon the mucous membranes, together with the diu- 
retic properties of the drug, renders turpentine an exceedingly 
valuable remedy in the treatment of gleet \ subacute gonorrhea, 
cJironic cystitis, spermatorrhea, prostatorrhea, pyonephrosis, etc. 

Contraindications. — Oil of turpentine should never be given 
to patients suffering from Bright's disease or acute inflammation 
of the gastro-intestinal or genito-urinary tracts. 

Administration. — Small doses of turpentine may be given on 
lumps of cut sugar, but usually preference is given to administra- 
tion in the form of a capsule or an emulsion, I fluidram (4.0 Cc.) 
of mucilage of acacia, if properly manipulated, emulsifying \ fluid- 
dram (2.0 Cc.) of oil of turpentine with 1 fluidounce (30.0 Cc.) of 
water. Flavoring substances can be incorporated in the emulsion, 
rendering the preparation not unpleasant to the taste. 

In giving turpentine its tendency to produce untoward manifes- 
tations, particularly of the genito-urinary tract, should be remem- 
bered, care being invariably exercised in the administration of the 
drug. 

For external use the drug may be used in full strength, diluted 
with some bland oil or ointment, or applied in the form of stupes. 

Turpentine is sometimes employed as an enema, in which case 
it should, of course, be mixed with some bland oil and mucilage 
of acacia in the form of an emulsion. 



Terebenum— Terebeni— Terebene. V. S. P. 

Definition. — A liquid consisting chiefly of dipentene and other hydrocarbons, 
obtained by the action of concentrated sulphuric acid in oil of turpentine and subse- 
quent rectification with them. 

Description and Properties. — A colorless or slightly yellowish, thin liquid 
having rather an agreeable thyme-like odor and an aromatic, somewhat terbinthinate 
taste. Only slightly soluble in water, but soluble in an equal volume of alcohol. 
Terebene should be kept in well-stoppered bottles, in a cool place protected from 
light. 

Dose.— 5-15 minims (0.3-1.0 Cc.) [8 minims (0.5 Cc), U. S. P.]. 

Physiological Action. — When applied externally terebene acts 
as a stimulant, germicide, antiseptic, and astringent. Internally, 
small doses act as a stimulant to the gastro-intestinal tract, large 
amounts being irritant and producing effects similar to those of 
turpentine. 

The drug is eliminated by the kidneys, bronchial mucous mem- 
branes, skin, bowels, etc., acting as a mild astringent and antiseptic 
at the points of elimination. 

Therapeutics. — Externally and Locally. — The inhalation of 
terebene — 20 minims (1.23 Cc.) daily — allays the cough of laryn- 
geal phthisis and has proved beneficial in irritative bronchial cough, 



328 A TEXT-BOOK OF MATERIA MEDICA. 

while a spray of terebene mixed with oil of eucalyptus and alcohol 
has been advised in whooping-cough. 

Internally. — Whether inhaled or taken into the stomach, terebene 
is a powerful stimulant, antiseptic expectorant in chronic bronchitis. 

The drug is of service in affections of either the upper or lower 
respiratory passages. In winter-cough, bronchorrhea, emphysema, 
and even in phthisis, it is an efficient remedy. 

Not only in bronchial affections is the drug valuable, but it has 
been used with striking success as a substitute for copaiba and oil 
of sandalwood in genito-urinary diseases. It has even been claimed 
to influence favorably the course of puerperal fever and to relieve 
the symptoms of flatulent dyspepsia. 

Administration. — Terebene may be given in emulsion or in 
mixtures associated with other expectorants and enclosed in cap- 
sules or dropped upon sugar. 



Terpini Hydras— Terpini Hydratis— Terpin 
Hydrate. U. S. P. 

Origin. — The hydrate of the diatomic alcohol terpin, prepared by mixing recti- 
fied oil of turpentine, alcohol, and nitric acid, allowing the mixture to stand for three 
or four days in shallow porcelain dishes, collecting the crystals which have formed, 
drying on absorbent paper, and recrystallizing in a cold solution of alcohol. 

Description and Properties. — Colorless, lustrous, rhombic prisms, nearly 
odorless, and having a slightly aromatic and somewhat bitter taste. Permanent in the 
air. Soluble in about 250 parts of water and in 10 parts of alcohol. Terpin hydrate 
should be kept in well-stoppered bottles. 

Dose. — 2-30 grains (0.12-2.0 Gm.) [2 grains (0.125 Gm.), U. S. P.]. 

Physiological Action. — Terpin hydrate is a powerful antiseptic, 
its action resembling that of turpentine, though inferior in strength. 

Therapeutics. — Externally and Locally. — The drug is used in 
the form of lozenges and as an inhalant in chronic tracheitis and 
clironic bronchitis. 

Internally. — Terpin hydrate may be used for the same purposes 
as terebene, being considered by some physicians superior to the 
latter drug in bronchial affections. 

Administration. — Terpin hydrate may be given in lozenges, 
emulsion, or aromatic elixir, although the most judicious method 
of administration, perhaps, is in capsules. 

Allied Compound. 

Terpinol is obtained by boiling terpin hydrate with dilute mineral acids. It 
occurs as an oily body with a hyacinthine odor. Insoluble in water, but readily sol- 
uble in alcohol and in ether. 

Terpinol is a valuable bronchial stimulant, and may be used for the same diseases 
of the respiratory passages for which terpin hydrate is recommended. 

It is best given in capsules, in doses of about 2 grains (o. 12 Gm.) each, repeated 
from four to six times a day. 



IRRITANTS AND COUNTERIRRITANTS. 2> 2 9 

Rhus Toxicodendron— Rhois Toxicodendri— Rhus 
Toxicodendron. (Non- Official.) 

(Poison Ivy. ) 

Origin. — The fresh leaves of Rhus radicans L., a climbing shrub indigenous in 
Canada and the greater part of the United States westward to the Rocky Mountains. 

Description and Properties.— Long-petiolate, trifoliate, the lateral leaflets 
sessile or nearly so, about 4 inches ( 10 Cm. ) long, obliquely ovate, pointed ; the ter- 
minal leaflets stalked, ovate or oval, pointed, with a wedge-shaped or rounded base ; 
the leaflets entire and glabrous or variously notched, coarsely toothed or lobed, more 
or less downy ; when dry, papery and brittle ; inodorous ; taste somewhat astringent 
and acrid. The fresh leaves abound in an acrid juice which darkens on exposure to 
air, and when applied to the skin produces inflammation and swelling. The leaves 
should therefore not be touched with the bare hands. 

The fresh leaves contain a volatile principle termed toxicodendrol by Pfaff. In 
addition to this active constituent the leaves contain tannin. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Physiological Action. — Externally and Locally. — The fresh 
leaves of this common plant are extremely irritant to the skin, 
generally acting as a marked vesicant and establishing severe local 
inflammation, manifested by acute dermatitis, excessive edema, and 
hyperemia. In many cases these effects are much less pronounced, 
while in certain individuals they are never occasioned by contact 
with or even chewing the leaves. As with poison sumach — Rhus 
venenata — the toxic influence of the plant derived from local appli- 
cation is apparently more virulent during the period of flowering. 

The inflammation somewhat resembles erysipelas, being rapidly 
diffused and accompanied by a general systemic disturbance, in- 
cluding abdominal pains, nausea, and vomiting, with perhaps diar- 
rhea, diuresis, and serous passages. Profuse diaphoresis and lum- 
bar and articular pains may also result. These symptoms cease 
after about ten days or a fortnight without other sequel than des- 
quamation of the affected surface. 

Internally. — The effects of the drug administered internally are 
to cause gastro-intestinal inflammation, with drowsiness and stupor, 
and occasionally delirium and convulsions. Vertigo, nausea, chilli- 
ness, thirst, weak and irregular cardiac movements, diaphoresis, 
muscular debility, and diuresis are also reported. 

Treatment of Poisoning. — Many remedies have been used, with 
varying efficacy, to allay the toxic effect of the drug. Dermal 
poisoning has been relieved by glycerite of carbolic acid or alkaline 
lotions. In the earlier stage of external irritation warm soapsuds 
and sodium bicarbonate have been successfully applied. Alum- 
curd, ammonia in a weak solution, solution of chlorinated soda, and 
many other agents have been employed to meet the requirements 
of certain stages of the affection. Orthoform or anesthesin in an 
ointment base, as oxide of zinc, is a useful analgesic. 

Therapeutics. — Externally and Locally. — The diluted tincture 
— 8 minims (0.5 Cc.) to 4 ounces (118 Cc.) of water — has met with 
some favor in the treatment of sprains, burns, etc. 

In weak solution with alcohol the remedy has been used as a 



330 A TEXT-BOOK OF MATERIA MEDIC A. 

stimulating application in cases of sprains, chilblains, burns, insect- 
stings, etc. 

Internally. — It has been recommended in so many affections that 
it is highly doubtful if it is valuable for any. 

The drug is in need of much 'more thorough investigation, there 
being widely diverse opinions regarding its therapeutic value. There 
is, however, sufficient testimony in its favor from competent author- 
ities to justify further examination and use of this extremely active 
remedy. 

Contraindications. — The meager knowledge we possess re- 
specting its true action in disease renders it impossible to mention 
any special contraindication to its employment. 

Administration. — The tincture is the only preparation used, 
and should be cautiously administered. 

II. AROMATIC VEHICLES AND CARMINATIVES. 
Anisum— Anisi— Anise. U. S. P. 

Origin. — The ripe fruit of Pi?npinella Anisum L., a plant indigenous in Western 
Asia and Egypt, and extensively cultivated in Europe. 

Description and Properties. — About y%-% inch (3-6 Mm.) long, ovate 
compressed laterally, grayish, finely pubescent, consisting of two mericarps, each with 
a flat face, and five light-brownish filiform ridges, and about fifteen thin oil-tubes, per- 
ceptible in transverse section by the aid of the microscope. Anise has an agreeable, 
aromatic odor and a sweet, spicy taste. It contains from 1^ to 3 per cent, of a vola- 
tile oil. It resembles the fruit of the conium, differing from it usually in being longer 
and more ovate, and having another odor and taste. The fruit of the conium has, 
moreover, but a single smooth mericarp without oil-tubes. 

Dose. — 8-30 grains (0.5-2.0 Gm.) [7^ grains (0.5 Gm.), U. S. P.]. 

Oleum Anisi— Olei Anisi— Oil of Anise. V. S. JP. 

Origin, — A volatile oil distilled from anise or from the fruit of Star anise, Illiciam 
verum. 

Description and Properties. — A colorless or pale-yellow, thin and strongly 
refractive liquid, having the characteristic odor of anise, and a sweetish, mildly aromatic 
taste ; neutral in reaction. It contains a stearopten anethol, C I0 H 12 O, and a methyl 
chavicol, C 10 H 12 O, upon which its properties in large part depend. 

Oil of anise should be kept in well-stoppered bottles, protected from light, and if 
it has separated into a liquid and a solid portion, it should be completely liquefied by 
warming before being dispensed. 

Dose. — 1-5 minims (0.06-0.3 ^- c -) [3 minims (0.2 Cc), U. S. P.]. 

Official Preparations. 

Aqua Anisi — Aquae Anisi— Anise Water. — Dose, %-i fluidounce (8.0-30.0 
Cc. ) [2 drams (16 Cc), U. S. P.]. 

Spiritus Anisi— Spiritus Anisi— Spirit of Anise. — Dose, 1-2 fluidrams (4.0- 
8.0 Cc.) [1 dram (4 Cc), U. S. P.]. 

Oil of anise is contained in the following preparations : 

Spiritus Aurantii Compositus ; Syrupus Sarsaparillse Compositus ; Tinc- 
tura Opii Camphorata ; Trochisci Glycyrrhizae et Opii. 

Physiological Action. — Anise is slightly antiseptic, stimulant, 
and carminative ; oil of anise is irritant if applied in full strength to 



AROMATIC VEHICLES AND CARMINATIVES. 331 

mucous membranes, stimulating both the digestive and circulatory 
apparatus, improving the appetite, and slightly strengthening and 
accelerating the heart's action. In very large doses it possesses 
mildly narcotic properties. It is excreted in the urine, sweat, and 
by the bronchial mucous membrane, the secretion from which it 
liquefies. 

Therapeutics. — Anise is employed to relieve flatulence in 
children, as a sedative expectorant, and as a vehicle to flavor 
medicines. 

Cinnamomum— Cinnamomi— Cinnamon. U. S. JP. 

Origin. — There are two official varieties of cinnamon : 1, the inner bark of the 
shoots of Cinnamomuvi zeylanicum Breyne, a tree about 30 feet high (9 M.), found in 
the forests of Ceylon (Ceylon cinnamon) ; 2, the bark of an undetermined species of 
Cinnamomum known as Cinnamomum saigonicum (Saigon cinnamon, Saigon cassia), 
from Saigon, the capital of French Cochin-China, where it is collected and exported. 

Description and Properties. — Most of the article brought to the United 
States is the cassia cinnamon. The varieties differ somewhat in appearance, and are 
found in the shops as quills of varying lengths, about -^V inch (I Mm.) or more in 
thickness, yellowish-brown in color, externally rough (Cassia), of fragrant odor, a 
sweet, aromatic taste, but less delicate than that of Ceylon cinnamon, which appears 
in large, closely rolled quills, composed of eight or more layers of bark of the thick- 
ness of paper ; pale yellowish-brown, the outer surface smooth, marked with wavy 
lines of bast-bundles ; of a very sweet, fragrant odor and a warm, aromatic, delicate 
taste. The Saigon cinnamon is found in the shops as large quills or broken pieces, J^ 
to y% inch (2 to 3 Mm.) thick ; the outer surface gray or light grayish-brown, with 
whitish patches, more or less rough and warty, transversely ridged and longitudinally 
wrinkled ; the inner surface cinnamon or dark brown, granular, and slightly striate, 
with short and granular fracture. It has a fragrant odor, and a sweet, warmly aromatic, 
and somewhat astringent taste. 

Constituents. — All the varieties contain volatile oil, tannin, mucilage, sugar, 
starch, a coloring principle, and a peculiar acid. 

The official oil of cinnamon is distilled from cassia cinnamon. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Official Preparations. 

Tinctura Cardamomi Composita — Tincturae Cardamomi Compositse — 
Compound Tincture of Cardamom. — Cardamom, 25 ; Saigon cinnamon, 25 ; cara- 
way, 12 ; cochineal, 5 ; glycerin, 50 ; diluted alcohol, q. s. ad icoo parts. Dose, 1-2 
fluidrams (4.0-8.0 Cc.) [1 dram (4 Cc. ), U. S. P.]. 

Tinctura Gambir Composita — Tincturae Gambiris Composita? — Compound 
Tincture of Gambir. — Gambir, 50 ; Saigon cinnamon, 25 ; diluted alcohol, q. s. ad 
1000 parts. Dose, y z -2 fluidrams (2.0-8.0 Cc.) [1 dram (4 Cc), U. S. P.]. 

Tinctura Lavandulae Composita — Tincturae Lavandulae Compositae — Com- 
pound Tincture of Lavender. — Dose, %-\ fluidram (2.0-4.0 Cc). (Formula given 
under Lavender.) 

Tinctura Cinnamomi (20 per cent.) — Tincturae Cinnamomi — Tincture of 
Cinnamon. — Dose, %-2 fluidrams (2.0-8.0 Cc.) [30 minims (2 Cc), U. S. P.]. 

Pulvis Aromaticus — Pulveris Aromatici — Aromatic Powder. — Dose, 10-30 
grains (0.6-2.0 Gm. ). (Formula given under Cardamomum.) 

Oleum Cinnamomi-OIei Cinnamomi— Oil of 
Cinnamon. U. S. i*. 

Origin. — A volatile oil distilled from Cassia cinnamon, yielding not less than 75 
per cent, by volume of cinnamic aldehyde. 

Description and Properties. — A yellowish or brownish liquid, becoming 



/ 



332 A TEXT-BOOK OF MA TERIA MEDICA. 

darker and thicker with age and exposure to the air, having the characteristic odor of 
cinnamon and a sweetish, spicy, burning taste. Specific gravity, 1 .045-1 .055 at 25 C 
Soluble in an equal volume of alcohol, the solution being slightly acid to litmus-paper ; 
also soluble in an equal volume of glacial acetic acid. It should be kept in well- 
stoppered bottles, in a cool place, protected from light. 

Constituents. — Oil of cinnamon contains variable quantities of hydrocarbons, 
but consists chiefly of cinnamic aldehyde, C 6 H 5 CHCHCOH, and when old or exposed 
to the air for a considerable time cinnamic acid and resin are formed. Cinnamic acid 
crystallizes in shining, colorless, odorless prisms, freely soluble in alcohol, ether, and 
boiling water. Chlorinated lime and hot dilute nitric acid oxidize it into oil of bitter 
almond and benzoic acid. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Official Preparations. 

Aqua Cinnamomi (0.2 per cent.) — Aquae Cinnamomi— Cinnamon Water. 

— Dose, ]/ 2 -\ fluidounce (15.0-30.0 Cc. ) [4 drams (16 Cc. ), U. S. P.]. 

Spiritus Cinnamomi (10 per cent.) — Spiritus Cinnamomi — Spirit of Cinna- 
mon. — Dose, 5-20 minims (0.3-1.2 Cc.) [30 minims (2 Cc), U. S. P.]. 



Cinnaldehydum— Cinnaldehyde— Cinnamic 
Aldehyde. U. S. P. 

Definition. — An aldehyde, C 6 H 5 CH:CH.COH, obtained from oil of cinnamon 
or prepared synthetically. It is the chief and essential constituent of oil of cinnamon, 
and should be present to the extent of about 75 per cent, by volume in a good oil. 

Description and Properties. — A colorless liquid, having a cinnamon-like 
odor and a burning, aromatic taste. It may be used for nearly all purposes in place of 
the official oil of cinnamon. Pure synthetic cinnamic aldehyde occurs in the market, 
and has to a great extent displaced the natural oil of cinnamon. Sparingly soluble 
in water, readily in alcohol, fixed and volatile oils. 

Dose. — Average dose, I minim (0.05 Cc.j, U. S. P. 

Physiological Action. — Cinnamon is an agreeable aromatic 
stimulant, carminative, stomachic, astringent, hemostatic, and anti- 
septic. The oil possesses germicidal properties. It has a marked 
action on the vasomotor system, causing flushing and stimulating 
peristalsis. In poisonous doses its action approximates that of 
phenol. 

Therapeutics. — The same as for other aromatics. It is much 
used to impart an agreeable flavor to medicinal compounds and as 
an adjuvant to other members of this group. 

Coriandrum— Coriandri— Coriander. U. S. JP. 

Origin. — The dried fruit of Coriandrum sativum L. , an annual herb about 2 feet 
(60.0 Cm.) high, indigenous in China and on the northeastern shore of the Mediter- 
ranean. Cultivated in Asia, Europe, and America. 

Description and Properties.- --Globular, about % inch (3 Mm.) in diameter, 
slightly pointed at the apex and crowned with the calyx-teeth at the base. The two 
concave merienrps cohere, enclosing a lenticular cavity, each furnished on the face 
with two oil-tubes; odor and taste agreeably fragrant and aromatic. 

Constituents. Coriander contains nearly \ of 1 per cent, of volatile oil, 13 
nt. of fatty matter, mucilage, and traces of tannin. 

Dose. — 8-30 grains (0.5-2.0 Gm.) [7^ grains (0.5 Gm.), U. S. P.]. 



AROMATIC VEHICLES AND CARMINATIVES. 333 

Oleum Coriandri— Olei Coriandri— Oil of Coriander. 

U. S. JP. 

Origin. — A volatile oil distilled from coriander. 

Description and Properties. — A colorless or slightly yellowish liquid, hav- 
ing the characteristic aromatic odor of coriander and a warm, spicy taste. It is one 
of the most stable of the volatile oils. Coriandrol, C 10 H 18 O, an alcohol, is its most 
characteristic ingredient. 

Dose. — 1— 15 minims (0.06-0.3 Cc. ) [3 minims (0.2 Cc). U. S. P.]. 

Physiological Action and Therapeutics, — The same as those 
of the other volatile oils. Frequently used as a corrective to pur- 
gative medicines. 

Foeniculum— Foeniculi— Fennel. U. S. I>. 

Origin. — The dried, nearly ripe fruit of Foeniculum vulgare Miller, a herba- 
ceous annual or perennial indigenous in Southern Europe and cultivated in Germany, 
France, and the United States. 

Description and Properties.— Oblong, nearly cylindrical, slightly curved, 
from l /e to ]/ 2 inch (4-12 Mm.) long, brownish or greenish-brown, readily separable 
into the two prominent merricarps, each with five light-brown, obtuse ribs, with four 
oil-tubes on the back and two or four upon the flat face; odor and taste aromatic, 
anise-like. 

Constituents. — Fennel contains from 2 to 4 per cent, of volatile oil, which is 
almost identical chemically with that of anise, 12. 5 per cent, of fixed oil, and sugar. 

Dose.— 8-30 grains (0.5-2.0 Gm.) [15 grains (I Gm.), U. S. P.]. 

Official Preparations. 

Confectio Sennae — Confectionis Sennse — Confection of Senna (0.5 percent.). 
— Dose, 1-2 drams (4.0-8.0 Gm. ) [60 grains (4 Gm.), U. S. P.]. (Formula given 
under Senna.) 

Infusum Sennae Compositum — Infusi Sennae Compositi — Compound Infu- 
sion of Senna. — Dose, 1-2 fluidounces (30.0-60.0 Cc. ) [4 drams (120 Cc), U. S. 
P.]. (Formula given under Senna.) 

Oleum Foeniculi— Olei Foeniculi— Oil of Fennel. 

v. s. r. 

Origin.— A volatile oil distilled from fennel. 

Description and Properties. — A colorless or pale-yellowish liquid, having 
the characteristic aromatic odor of fennel and a sweetish, mild, and spicy taste. Sol- 
uble in an equal volume of alcohol. It should be kept in well-stoppered bottles, in a 
cool place, and if it has partly or wholly solidified, it should be completely liquefied 
by warming before being dispensed. 

Constituents. — It has constituents similar to those of the oil of anise. 

Dose. — 1-5 minims (0.06-0.3 Cc.) [3 minims (0.2 Cc), U. S. P.]. 

Official Preparations. 

Aqua Foeniculi (0.2 per cent.) — Aquae Fceniculi — Fennel Water. — Dose, %- 
I fluidounce (8.0-30.0 Cc ) [4 drams (16 Cc. ), U. S. P.]. 

Pulvis Glycyrrhizae Compositus — Pulveris Glycyrrhizse Compositi — Com- 
pound Liquorice Powder.— Dose, y z -2 drams (2.0-8.0 Gm.) [60 grains (4 Gm.), 
U. vS. P.]. (Formula given under Senna.) 

Spiritus Juniperi Compositus — Spiritus Juniperi Compositi — Compound 
Spirit of Juniper (0.5 per cent.). — Dose, 2-4 fluidrams (8.0-15.0 Cc. ). (Formula 
given under Carum. ) 

Physiological Action and Therapeutics are similar to those 
of anise. 



334 A TEXT-BOOK OF MA TERIA MEDICA. 

Carum—Cari— Caraway. 77. S. JP. 

Origin. — The dried fruit of Carum Carvi L., a biennial plant native to Central 
and Western Asia. It is cultivated in Europe and in the United States. 

Description and Properties. — Oblong, laterally compressed, about \ to \ 
inch (4-5 Mm.) in length, tapering somewhat at the ends, brown, with five yellowish, 
filiform ribs and six oil-tubes. Caraway has an agreeable odor and a sweetish, spicy 
taste. 

Constituents. — It contains from 5 to 7 per cent, of a volatile oil. 

Dose. — 15-30 grains (1.0-2.0 Gm.) [25 grains (1 Gm.), U. S. P.]. 

Official Preparation. 

Tinctura Cardamomi Composita — Tincturae Cardamomi Compositae — 
Compound Tincture of Cardamom. — Dose, 1-2 fluidrams (4.0-8.0 Cc.) [i dram 
(4 Cc), U. S. P.]. (Formula given under Cardamomum.} 

Oleum Cari— Olei Cari— Oil of Caraway. U. S. P. 

Origin. — A volatile oil distilled from caraway. 

Description and Properties.— A colorless or pale-yellow, thin liquid, hav- 
ing the characteristic aromatic odor of caraway and a mild, spicy taste. Soluble in 
an equal volume of alcohol, this solution being neutral to litmus-paper. 

By fractional distillation the oil may be separated into two portions : a light hydro- 
carbon with but little odor and taste, carvene; and a ketone having an agreeable cara- 
way odor, carvone (C 10 H u O). 

Dose. — 1-10 minims (0.6-0.66 Cc.) [3 minims (0.2 Cc), U. S. P.]. 

Official Preparation. 

Spiritus Juniperi Compositus — Spiritus Juniperi Compositi — Compound 
Spirit of Juniper. — Oil of Juniper, 8 ; oil of caraway, 1 ; oil of fennel, I ; alcohol, 
1400; water, q. s. ad 1000 parts. Dose, 2-4 fluidrams (8.0-15.0 Cc. ) [2 drams (8 Cc. ), 
U. S. P.]. 

Physiological Action and Therapeutics. — The same as those 
of the other aromatic oils. 

Myrrha— Myrrhae— Myrrh. TJ. S. I*. 

Origin. — A gum-resin obtained from Commiphora Myrrha (Nees) Engler, a 
shrub or small tree " forming the chief underwood of the Arabian and African forests 
along the shores of the Red Sea." 

Description and Properties. — Roundish, irregular tears or masses, dusty 
brownish-yellow or reddish-brown ; fracture waxy, somewhat splintery, translucent on 
the edges, sometimes marked with whitish veins ; odor balsamic ; taste aromatic, bitter, 
and acrid. It is a dried-up emulsion-like juice. It contains 60 per cent, of gum, 35 
per cent, of resin, and 3 to 4 per cent, of a volatile oil of unknown composition, thought 
by Fliickiger to contain carvone. It is now thought that there is no carvone in this oil. 

Dose. — 5-30 grains (0.3-2.0 Gm. ), in pills or emulsion [7^ grains (0.5 Gm. ), 
U. S. P.]. 

Official Preparations. 

Mistura Ferri Composita — Misturae Ferri Compositae — Compound Iron 
Mixture. — Dose, ^-2 fluidounces (15-60 Cc.) [4 drams (16 Cc), U. S. P.J. 

Pilulae Aloes et Myrrhae — Pilulas (ace.) Aloes et Myrrhae — Pills of Aloes 
and Myrrh. — Dose, 2-5 pills [2 pills, U. S. P.]. 

Tinctura Aloes et Myrrhae — Tincturae Aloes et Myrrhae —Tincture of Aloes 
and Myrrh (10 per cent.). — Dose, ^-2 fluidrams (2-8 Cc.) [30 minims (2 Cc), 
U. S. P.]. 

Tinctura Myrrhae — Tincturae Myrrhae — Tincture of Myrrh (20 per cent.). — 
Dose, 15-60 minims (1-4 Cc. ) [15 minims (1 Cc), U. S. P.]. 



AROMA TIC VEHICLES AND CARMINA TIVES. 335 

Physiological Action. — Myrrh is astringent, disinfectant, slightly 
antiseptic, and stimulant. Its action resembles that of the aro- 
matics, stimulating the appetite and acting as a carminative, excess- 
ive doses causing nausea and vomiting. 

The drug is eliminated by the mucous membranes generally, aug- 
menting and disinfecting their secretions. It possesses emmena- 
gogue properties. 

Therapeutics. — As a stimulant and astringent myrrh is service- 
able as a mouth-wash in ptyalism and spongy gums and in ozena. 
It is useful as a gargle in pharyngitis, relaxed throat, etc., and as an 
injection in leukorrhea, the latter disease, as well as cystitis, being 
favorably influenced by the internal administration of the drug. It 
has been used internally, with considerable success, as a stimulant 
expectorant in bronchorrhea and chronic bronchitis, and as a sto- 
machic in atonic dyspepsia. 

Administration. — Myrrh may be given internally in the form 
of an emulsion or pills. The tincture, either in full strength or 
diluted, is chiefly employed externally. 



Eucalyptus— Eucalypti— Eucalyptus. U. S. JP. 

Origin. — The dried leaves of Eucalyptus globulus Labillardiere, collected from the 
older part of the tree. The blue-gum tree is a rapid grower, attaining a height of 200 
to 300 feet (60-90 M.). It is native to Australia, but is cultivated in various portions 
of Europe, Africa, and the United States with the view of rendering malarial districts 
habitable by its antiseptic exhalations. Its efficacy in this direction is due solely to its 
using large quantities of water for its growth, thereby depriving the malarial-bearing 
mosquitoes of the marshy grounds in which they develop their larvae. 

Description and Properties. — Petiolate, lanceolate, scythe-shaped, from 6 
to 12 inches (15-30 Cm.) long, rounded below, tapering above, entire, leathery, gray- 
ish-green, glandular, feather-veined between the midrib and marginal veins ; odor 
strongly camphoraceous ; taste pungently aromatic and somewhat cooling, bitter, and 
astringent. 

The most important constituent is a volatile oil, of which the leaves yield about 6 
per cent. 

Dose. — %-2 drams (2.0-8.0 Gm.) [30 grains (2 Gm.), U. S. P.], 

Official Preparation. 

Fluidextractum Eucalypti— Fluidextracti Eucalypti — Fluidextract of Eu- 
calyptus. — Dose, 5-60 minims (0.3-4.0 Cc). 



Oleum Eucalypti— Olei Eucalypti— Oil of 
Eucalyptus. XT. S. JP. 

Origin. — A volatile oil distilled from the fresh leaves of Eucalyptus globulus 
Labillardiere and from other sources. 

Description and Properties. — A colorless or faintly yellowish liquid, having 
a characteristic, aromatic, somewhat camphoraceous odor and a pungent, spicy, and 
cooling taste. Soluble in all proportions in alcohol. This oil consists of a mixture of 
hydrocarbons, the most striking of which is eucalyptol, probably identical with cineol, 
C, H 18 O, one of the most widely distributed of the oxides of the hydrocarbons. It 
should be kept in well-stoppered bottles, in a cool place, protected from light. 

Dose. — 5-15 minims (0.3-1.0 Cc.) [8 minims (0.5 Cc), U. S. P.]. 



336 A TEXT-BOOK OF MATERIA MEDICA. 

Eucalyptol— Eucalyptol— Eucalyptol. U. 8. P. 

Definition. — An organic oxide (cineol) obtained from the volatile oil of Eucalyp- 
tus globulus and from other sources. It is also found in a great many other volatile 
oils ; oil of cajuput being one of those most widely known. 

Description and Properties. — A colorless liquid, having a characteristic, 
aromatic, and distinctly camphoraceous odor and a pungent, spicy, and cooling taste. 
Soluble in all proportions in alcohol. 

Dose.— 5-10 minims (0.3-0.6 Cc.) [5 minims (0.3 Cc), U- S. P.]. 

Physiological Action. — Externally and Locally. — Locally ap- 
plied, the oil of eucalyptus and eucalyptol are more or less irritant, 
though perhaps less active than many volatile oils. They do not 
differ in any particular regard from others of this class. The re- 
semblances of eucalyptus to quinine are largely fanciful. 

Therapeutics. — Eucalyptus is a valuable remedy in chronic 
inflammation of mucous membranes, especially in atrophic rhinitis, 
where it is best applied in spray combined with a liquor petroleum 
excipient in the proportion of 30-60 minims (2-4 Cc. to the ounce 
—33 Gm.). 

It has proved of service in acute and chronic skin diseases, 
notably simple dermatitis, and in chronic forms of eczema and 
psoriasis. As others of the turpentine series, it is a stimulant to 
sluggish ulcers. 

The chief value of this drug lies perhaps in its effects upon the 
urine in its elimination. It is an active antiseptic and is useful in 
cystitis and pyelitis. 

As a stimulant expectorant eucalyptus is of great value, equal- 
ing, if not being superior to, any other remedy in bronchorrhea, 
pulmonary gangrene, and fetid bronchitis > associated or not with 
phthisis. Chronic or catarrhal conditions of the lungs and bronchi 
only are benefited by eucalyptus, acute affections of the broncho- 
pulmonary mucous membrane contraindicating its use. A solution 
of oil of eucalyptus is used as an antiseptic inhalation in diphtheria. 

Administration. — The fresh leaves may be employed as poul- 
tices. Any of the preparations may be used, but for internal pur- 
poses the oil, or eucalyptol, is preferable, although a good fluid 
extract is an agreeable form of the medicine. The oil, or euca- 
lyptol, may be given in an emulsion or in capsules, for topical use 
being diluted with alcohol or oil or incorporated in suppositories or 
ointments. 



Oleum Cajuputi— Olei Cajuputi— Oil of Cajuput. 

IT. 8. P. 

Origin. — A volatile oil distilled from the fresh leaves and twigs of Melaleuca 
leucadendron L., a tree with crooked stem and scattered branches, resembling the 
weeping willow, indigenous in the East Indies. It should yield not less than 55 per 
cent, by volume of cineol. 

Description and Properties. — A light, thin, bluish-green, or, after rectifica- 
tion, colorless liquid, having a peculiar, agreeable and distinctly camphoraceous odor, 
and an aromatic, bitterish taste. Specific gravity, 0.925 at 25 C. With an equal 



AROMATIC VEHICLES AND CARMINATIVES. 337 

volume of alcohol it affords a clear solution, which either has a slightly acid reaction 
or, in the case of the rectified oil, is neutral to litmus-paper. 

Constituents. — The chief constituent is cineol. 

Dose. — 1-5 minims (0.06-0.3 Cc.) [8 minims (0.5 Cc), U. S. P.]. 

Physiological Action and Therapeutics are identical with those 
of the oil of cloves. 

Cardamomum— Cardamomi— Cardamom. TJ. S. JP. 

Origin. — The dried, nearly ripe fruit of Eleltaria repens (Sonnerat) Baillon, a 
perennial plant 6 to 10 feet (1.8— 3.0 M.) high. 

Cardamom is indigenous in Hindustan, in the mountainous regions of Malabar. 

The same plant furnishes three varieties of cardamoms, known in commerce as 
the shorts, short-longs, and long-longs. 

Description and Properties. — Ovoid or oblong, from § to f inch (12 Mm.- 
2 Cm.) long, obtusely triangular, rounded at the base, beaked, longitudinally striate; 
of a pale-buff color, three-celled, with a thin, leathery, nearly tasteless pericarp and a 
central placenta. The seeds are about A inch (5 Mm.) long and \ inch (3 Mm.) 
broad, reddish-brown, angular, rugose, depressed at the hilum, surrounded by a thin 
membranous arillus. They have an agreeable odor and a pungent, aromatic taste. 

Dose. — 5-15 grains (0.3-1.0 Gm.) [15 grains (1 Cm.), U. S. P.]. 

Official Preparations. 

Tinctura Cardamomi (20 per cent.) — Tincturae Cardamomi — Tincture of 
Cardamom. — Dose, 1-2 nuidrains (4.0-8.0 Cc.) [1 dram (4 Cc), U. S. P.]. 

Tinctura Cardamomi Composita — Tincturae Cardamomi Compositae — 
Compound Tincture of Cardamom. — Cardamom, 25 ; Saigon cinnamon. 25 ; cara- 
way, 12; cochineal, 5 ; glycerin, 50 ; dilute alcohol, q. s. ad 1000 parts. Dose, 1-2 
fluidrams (4.0-8.0 Cc. ) [1 dram (4 Cc), U. S. P.]. 

Pulvis Aromaticus — Pulveris Aromatici — Aromatic Powder. — Saigon cinna- 
mon, 35 ; ginger, 35 ; cardamom, 15 ; nutmeg, 15. Dose, 10-30 grains (0.6-2.0 Gm.) 
[15 grains (1 Gm.), U. S. P.]. 

There is also a fluidextract, fiuidextract aromaticum, made from this powder. 
Dose, 10-30 minims (0.6-2.0 Cc ) [15 minims (1 Cc), U. S. P.]. 

Antagonists and Incompatibles. — Free acids are incompatible 
with the compound tincture of cardamom, separating insoluble car- 
minic acid in it. 

Physiological Action. — In this respect cardamom conforms to 
the general character of the Aromatic Group. 

Therapeutics. — Essentially the same as for other members of 
this group. Cardamom is used principally as an adjuvant to other 
aromatics, stimulants, stomachics, and carminatives. 

Calamus— Calami— Calamus. 77. S. P. 

(Sweet Flag.) 

Origin. — The unpeeled, dried rhizome of Acorns Calamus L., a plant indigenous 
in North America, Europe, and Western Asia, growing in swamps and along the 
shores of streams and ponds. 

Description and Properties. — Calamus is found in subcylindrical sections 
of various lengths, about I inch (2 Cm.) broad, externally reddish-brown, internally 
whitish, of a spongy texture, breaking with a short, corky fracture, showing numerous 
oil-cells and scattered wood-bundles. It has a strong aromatic, fragrant odor and a 
warm, peculiar, bitterish taste. Calamus contains from 1 to 2 per cent, of volatile oil 
possessing the odor and taste of calamus, a glycosid (acorin) in the form of a bitter, 
yellow syrupy liquid, besides calamine, choline, resin, starch, and mucilage. 

Dose. — 15-60 grains (1.0-4.0 Gm.) [15 grains (1 Gm.), U. S. P.]. 

22 



338 A TEXT-BOOK OF MA TERIA MEDICA. 

Official Preparation. 

Fluidextractum Calami — Fluidextracti Calami — Fluidextract of Calamus. 

— Dose, 15-60 minims (1.0-4.0 Cc.) [30 minims (2.0 Cc. ), U. S. P.]. 

Physiological Action and Therapeutics. — The action of cala- 
mus is similar to that of anise, but is more tonic than the latter. 
Large doses of the volatile oil produce tetanic convulsions. 

It is used for the same purposes as anise, but probably possesses 
more stomachic and carminative properties. 

Oleum Lavandulae Florum— Olei Lavandulae 
Florum— Oil of Lavender Flowers. U. S. J*. 

Origin. — A volatile oil distilled from fresh flowering tops of Lavandula offici- 
nalis Chaix. Lavender is a native to Southern Europe and cultivated in gardens. 

Description and Properties. — A colorless or yellowish liquid, having the 
fragrant odor of lavender flowers and a pungent and bitterish taste. Soluble in all 
proportions of alcohol. It should be kept in well -stoppered bottles, in a cool place, 
protected from light. 

Dose. — 1-5 minims (0.06-0.03 Cc.) [3 minims (0.2 Cc), U. S. P.]. 

Official Preparations. 

Spiritus Lavandulae (5 percent.) — Spiritus Lavandulae — Spirit of Lavender. 
— Dose, l / z -\ fiuidram (2.0-4.0 Cc.) [30 minims (2 Cc), U. S. P.]. 

Tinctura Lavandulae Composita — Tincturae Lavandulae Compositae— Com- 
pound Tincture of Lavender. — Oil of lavender, 8 ; oil of rosemary, 2 ; Saigon 
cinnamon, 20; cloves, 5 ; nutmeg, IO; red saunders, 10 ; alcohol, water, aa q. s. ad 
1000 parts. Dose, ]/ z -\ fiuidram (2.0-4.0 Cc.) [30 minims (2 Cc), U. S. P.]. Com- 
pound tincture of lavender is an ingredient of liquor potassii arsenitis. 

Physiological Action and Therapeutics are the same as those 
of other volatile oils mentioned in this group. 

Mentha Piperita— Menthae Piperitae— Peppermint. 

U. S. JP. 

Origin. — The dried leaves and flowering tops of Mentha piperita Smith, a peren- 
nial plant found in damp places in England and other European countries and in North 
America. 

Peppermint contains about I per cent, of a volatile oil — its most important con- 
stituent. 

Oleum Menthae Piperitae— Olei Menthae Piperitae— 
Oil of Peppermint. U. S. JP. 

Origin. — A volatile oil distilled from the fresh or partly dried leaves and flower- 
ing tops of peppermint, yielding not less than 8 per cent, of ester, calculated as menthyl 
acetate, and not less than 50 per cent, of total menthol. 

Description and Properties. — A colorless liquid, becoming darker and 
thicker by age and exposure to the air, having the characteristic strong odor of pepper- 
mint and a strongly aromatic, pungent taste, followed bv a sensation of cold upon 
inhalation. It forms a clear solution with an equal volume of alcohol, becoming 
turbid when further diluted, and is soluble in all proportions in carbon disulphide and 
in glacial acetic acid. 

When exposed to a freezing temperature the oil becomes thick' and cloudy, and 
separates crystals of menthol, to which it owes its peculiar odor. 

Dose. — 1-5 minims (006-0.} Cc.) [3 minims (0.2 Cc. ), U. S. P.], 



AROMA TIC VEHICLES AND CARMINA LIVES. 339 

Official Preparations. 

Aqua Menthse Piperita (0.2 per cent.)— Aquae Mentha; Piperita; — Pepper- 
mint Water. — Dose, y 2 -\ fluidounce (15.0-30.0 Cc.) [4 drams ( 16 Cc. ), U. S. P.]. 

Spiritus Mentha; Piperita; (10 per cent.)— Spiritus Mentha; Piperita;— Spirit, 
or Essence, of Peppermint.— Dose, 5-60 minims (0.3-0.4 Cc.) ho minims (2 Cc), 
U. S. P.]. \ J> 

Spirit of peppermint is an ingredient of mistura rhei et sodse. 

Menthol— Menthol— Menthol. U. S. JP. 

Definition.— A secondary alcohol, C 6 H 9 (CH 3 )(OH) (C 3 H 7 ) 1 : 3 : 4, obtained 
from the oil of Mentha piperita L. or other peppermint oils. 

Description and Properties. — Colorless, acicular, or prismatic crystals, 
having a strong and pure odor of peppermint and a warm, aromatic taste, followed by 
a sensation of cold when air is inhaled. Menthol is but slightly soluble in water, but 
imparts to the latter its odor and taste. It is freely soluble in alcohol, ether, chloroform, 
carbon disulphide, and glacial acetic acid. It is a saturated secondary alcohol, with the 
following formula : 



C— H 
I 

C— H 
/\ 
H,=C C— H— OH 



I I 



I 
H 

ClL 



Dose. — Yz-i grains (0.03-0.12 Gm. ). 

Physiological Action and Therapeutics. — Externally and Lo- 
cally. — Menthol is an antiseptic, antipruritic, analgesic, and anes- 
thetic, as well as a germicide. It is used for the same purposes as 
oil of cloves. It is used extensively in headache, being rubbed 
on the forehead. Owing to its analgesic properties, it is used in 
the form of an ointment in various strengths for painful hemor- 
rhoids, burns, boils, and superficial inflammations. 

The oil of peppermint, or menthol, is an ingredient of many- 
sprays and lotions for the treatment of diseases of the ear, nose, and 
throat. 

As .an antipruritic menthol is a valuable remedy to relieve the 
itching of eczema, pruritus, urticaria, etc. It should be dissolved 
in oil for this purpose — in severe cases 50 grains to 1 ounce (3.2 
Gm. to 30.0 Cc). 

Internally. — The uses of oil of peppermint are similar to 
those of other aromatic oils, it being a valuable carminative, stimu- 
lant, antifermentative, and antispasmodic. In small doses menthol 
has been given to allay nausea and vomiting and to relieve the 
pain of gastralgia. 



34-0 A TEXT-BOOK OF MATERIA MED/CA. 

Mentha Viridis— Menthae Viridis— Spearmint. 

Tj • &• Jr • 

Definition. — The dried leaves and flowering tops of Mentha spicata L. 

This is one of the mints, found in the same localities as peppermint, and containing, 
like the latter drug, a volatile oil forming its active constituent. It possesses milder 
properties than peppermint, although similar to it in its action and uses. To some 
people it has a more agreeable taste than peppermint, and in infantile cases it is usually 
preferred. 

Official Preparations. 

Aqua Menthae Viridis — Aquae Menthae Viridis — Spearmint Water. 

Spiritus Menthae Viridis — Spiritus Menthae Viridis — Spirit, or Essence, of 
Spearmint. Dose, 30 minims (2 Cc), U. S. P. 

Oleum Menthae Viridis— Olei Menthae Viridis — Oil of Spearmint. — The 
dose of the oil of spearmint and of the above preparations is the same as for the corre- 
sponding oil and preparations of peppermint. 

Thymol— Thymol— Thymol. V. S. P. 

Origin. — A phenol, C 6 H 3 .(CH 3 ).(OH)(C 3 H 7 ) 1:3:4, occurring in the volatile 
oils of Thymus vulgai'is L., and in some other volatile oils. 

Description and Properties. — Large, colorless, translucent crystals of the 
hexagonal system, having an aromatic, thyme-like odor and a pungent, aromatic taste, 
with a very slight caustic effect upon the lips. Its specific gravity as a solid is 1. 030, 
but when liquefied by fusion it is lighter than water. It is soluble in about 1 100 parts 
of water and in less than its own weight of alcohol, ether, or chloroform ; also readily 
soluble in carbon disulphide, glacial acetic acid, and in fixed or volatile oils. When 
triturated with about equal quantities of camphor, menthol, or chloral, it liquefies. 

Dose. — 1-5 grains (0.06-0.3 Gin.) [ 2 grains (0.125 Gm. ), U. S. P.]. 

Thymolis Iodidum— Thymolis Iodidi— Thymol 
Iodide. U. S. P. 

(Aristol.) 

Definition.— Dithymol-diiodide, (C 6 H 2 .CH 3 .C 3 H 7 .0I) 2 , obtained by the conden- 
sation of two molecules of thymol (a methylisopropylphenol) and the' introduction 
into its phenolic group of two atoms of iodine. It contains 45 per cent, of iodine. 



A 



CH 
C 



HC CH HC C C CH 

II I II I I l| 

HC COH HC COI IOC CH 

V x ^ V 

c c c 

C»H, c 3 H 7 C 3 H 7 

Thymol. Dithymol-diiodide (thymolis iodidum). 

Description and Properties. — A bright, chocolate-colored or reddish-yellow, 
bulky powder, almost tasteless, and having a slight aromatic odor. Insoluble in water 
an 1 glycerin, soluble with difficulty in alcohol, readily soluble in fatty oils and in ether, 
vaseline, chloroform, and collodion. 

Allied and Derived Compounds. — Many other derivatives or compounds of 
thymol have been suggested for therapeutic use-— e. g. t thymoial (thymol -carbonate), 
thymacetin (analogous \o phtnacetin), thymoform (condensation product of thymol and 
formaldehyde), iodothymoform (iodized thymoform), mercury compound of thymol, 
thymosaloL etc. 



AROMATIC VEHICLES AND CARMINATIVES. 341 

Physiological Action. — Thymol is a powerful antiseptic, being 
ten times less poisonous than carbolic acid because of its slow ab- 
sorption, yet as an antiseptic far superior to it. While stimulant, it 
is not irritant or corrosive. It is also a deodorant, disinfectant, 
parasiticide, and local anesthetic, as well as an antipruritic, anti- 
pyretic, and antifermentative. 

Absorption and Elimination. — It is eliminated chiefly by the 
lungs and kidneys, producing some irritation at the points of 
elimination. The urine is increased in quantity, often assuming a 
dark-greenish hue, due to dioxybenzols. 

Untoward Action. — The following symptoms have been pro- 
duced by the administration of large doses : burning sensation in 
the mouth and stomach, persisting in some instances for days, 
accompanied by pain and tenderness under pressure. According 
to Balz, " perspiration is sometimes observed, and occasionally a 
transient buzzing in the ears and deafness." 

Poisoning. — In addition to untoward manifestations, there may 
be nausea and vomiting, profuse sweating, great reduction of tem- 
perature, dizziness, violent delirium, and collapse. 

Therapeutics. — Externally and Locally. — The applications of 
thymol in surgery are identical with those of carbolic acid. 

Crocker in 1878 introduced it as an efficient remedy in certain 
skin diseases. It probably owes its value in these cases to its anti- 
pruritic and antiparasitic properties. 

It is also extensively used in diseases of the nose, throat, and 
ear, and in certain disorders of the genito-nrinary tract. Thymol 
is also administered by inhalation in certain broncho-pulmonary 
disorders. 

Internally. — Thymol is used for the same purposes as other 
antiseptics, such as carbolic acid, resorcin, beta-naphtol, etc. 

Martini highly recommends it as an intestinal antiseptic in the 
treatment of diarrhea, dysentery, and typhoid fever. 

It has been employed with some success in limiting fermen- 
tation during a proteid diet in the treatment of diabetes. It has 
also been favorably recommended in phthisis, vesical catarrh, sto- 
matitis, and diphtheria. Thymol is the most efficient anthelmintic 
for the hook-worm, Uncinaria duodenale and Uncinaria americana, 
in doses of 5-20 grains. For the action of aristol see iodine. 

Administration. — It may be applied externally in solution 
(1 : 1000), as an ointment (1-10 per cent.), or in the form of thymol 
gauze as a surgical dressing (1 per cent, of thymol). 

For internal use it should be given in pills or capsules. 



342 A TEXT-BOOK OF MA TERIA MEDICA. 

UL CONDIMENT GROUP. 
Capsicum— Capsici— Capsicum. 77. S. P. 

(Cayenne Pepper.) 

Origin. — The dried ripe fruit of Capsicum fastigiatum Blume, deprived of its calyx. 
Capsicum fastigiatum is a small crooked-branched shrub, I to 2 feet (30.0-60.0 Cm.) 
high, indigenous in tropical America and Asia, and cultivated in gardens. The 
fruit is an oblong-conical pod from y z to % inch (8-19 Mm.) long, of a crimson or 
yellow color. It encloses two or three cells containing flat, reniform, yellowish seeds, 
attached to a thick, central placenta. These pods when dried and ground form capsi- 
cum, which has a peculiar odor and an intensely hot, aromatic taste. This ground 
product is of a bright-red color, fading upon long exposure to the light. Capsicum of 
the marke usually consists of several species ground together, and is often adulterated 
with sawdust and sometimes with red lead. 

Constituents. — Capsicum contains capsaicin, an acrid principle found in the 
greatest amount in the African product ; also a volatile alkaloid, fixed and volatile 
oil, and fat acids. 

Dose. — 3-5 grains (0.2-0.3 Gm. ) [1 grain (0.065 Gm,), U. S. P.J. 

Official Preparations. 

Fluidextractum Capsici — Fluidextracti Capsici — Fluidextract of Capsicum. 
Dose, y 2 -2 minims (0.03-0.12 Cc. ) [1 minim (0.05 Cc. ), U. S. P.]. 

Emplastrum Capsici — Emplastrum (ace. ) Capsici — Capsicum Plaster. For 
external use. 

Oleoresina Capsici — Oleoresinae Capsici — Oleoresin of Capsicum. — Dose, 
y~i minim (0.015-0.06 Cc. ) [^ grain (0.03 Gm.), U. S. P.]. 

Tinctura Capsici — Tincturae Capsici — Tincture of Capsicum. — Dose, 5-20 
minims (0.3-1.2 Cc.) [8 minims (0.5 Gm. ), U. S. P.]. 

Physiological Action. — Externally and Locally. — Capsicum is 
an irritant and rubefacient, producing vesication if kept in contact 
with the skin for a long time. It so irritates the mucous membrane 
of the mouth and nose as to induce sneezing. 

Internally. — Digestive System. — Capsicum is a powerful gastro- 
intestinal stimulant, increasing the flow from the salivary, gastric, 
and intestinal glands. It increases the blood-supply to, and stimu- 
lates the walls of, the stomach, occasioning a sense of heat. It is 
a powerful carminative. Large doses produce great irritation in 
the stomach and bowels. 

Circulatory System. — It is a powerful stimulant to the heart, 
greatly increasing the strength and rapidity of its action. 

Absorption and Elimination. — It is chiefly eliminated by the kid- 
neys, increasing the flow of urine. Large doses may produce 
vesical tenesmus, and aphrodisiac effects have sometimes been pro- 
duced. 

Therapeutics. — Externally a?id Locally. — Owing to its counter- 
irritant action, capsicum is employed to relieve lumbago, torticollis, 
neuralgia, rheumatic pains, and acute inflammation of the skin or 
mucous membrane. An infusion or the diluted tincture is an 
excellent gargle in relaxed uvula, phary?igitis, and the angina of 
scarlet fever. 

The tinctures of capsicum and cantharides have been used to 
stimulate the scalp in the various forms of alopecia. The tincture 



CONDIMENT GROUP. 343 

is frequently used as a domestic remedy for the benefit of chilblains 
and toothache. 

Internally. — Capsicum is a most valuable stomachic in an atonic 
condition of the digestive organs, and a very efficient remedy in 
the irritable and catarrhal conditio?is of the stomach due to the ex- 
cessive use of alcohol. 

The tincture of capsicum or the powdered drug, added to hot 
water or to hot water and whisky, makes a valuable and rapid car- 
diac and vascular stimulant. 

Contraindications. — Capsicum and its preparations should not 
be given in acute inflammatory affections of the gastro-intestinal 
and genito-urinary tracts. 

Administration. — The oleoresin and the powder should be 
given in pills or capsules. The fluidextract and the tincture should 
be administered well diluted with water. 



Piper— Piperis— Pepper. U. S. -P. 

(Black Pepper. ) 

Origin. — The dried unripe fruit of Piper nigrum L., a knotted, pointed- 
branched, aromatic, climbing shrub, indigenous in India, and cultivated in many of 
the East Indian and Philippine and some of the West Indian islands. 

Constituents. — Its important constituents are a volatile oil ( 1 to 2 per cent.) ; 
a neutral principle, piperin (6 to 8 per cent.) ; and a pungent, soft, dark-green resin, 
to which the acrid taste and medicinal properties of pepper are due. 

Dos©. — 5-20 grains (0.3-1.2 Gm.) [7^ grains (0.5 Gm.), U. S. P.]. 

Official Preparations. 

Oleoresina Piperis — Oleoresinae Piperis — Oleoresin of Pepper. — Dose, %-\ 
grain (0.015-0.06 Gm.) \y z grain (0.03 Gm.), U. S. P.]. 

Piperinum — Piperini — Piperin. — Origin. — A feebly basic substance (CH 2 2 .- 
C 6 H 3 , CH :CH.CH : CH.CON.C 5 H 10 ) obtained from pepper, as well as from other 
plants of the natural order Piperacece. 

Description atid Properties. — Colorless or pale-yellowish, shining, prismatic crys- 
tals, odorless, and almost tasteless when first taken into the mouth, but after a while 
producing a sharp, biting sensation. Permanent in the air; almost insoluble in water, 
but soluble in 15 parts of alcohol and in 1 part of boiling alcohol. 

Dose. — 1-10 grains (0.03-0.6 Gm.) [3 grains (0.2 Gm.), U. S. P.]. 

Derivative Compound. 

Piperonal — Heliotropin. — Obtained from piperic acid by oxidation. It occurs 
in small white crystals, soluble in about 600 parts of cold water, and very readily 
soluble in alcohol and ether. The dose is 10-15 grains (0.6-1.0 Gm.). It has been 
used as an antiseptic and antipyretic. 

Physiological Action and Therapeutics of pepper and its 
preparations are almost identical with those of capsicum. 

Pepper, particularly piperin, possesses antiperiodic and antiseptic 
properties to a greater extent than capsicum. 



344 A TEXT-BOOK OF MATERIA MEDICA. 

Myristica— Myristicae— Nutmeg. U. S. P. Macis— 
Macidis— Mace. U. S. P. 

Definition. — The kernel of the ripe seeds of Myristica fragrans Houttuyn. 

Origin. — The seed (Myristica) and the membrane, "arillode," investing the 
kernel i Mace) of Alyristica fragrans Houttuyn, a tree about 30 feet (9 M.) high, found 
in the Molucca Islands and cultivated in the East Indies. 

Oleum Myristicae— Olei Myristicae— Oil of Nutmeg. 

U. S. JP. 

Origin. — A volatile oil distilled from myristica. 

Description and Properties. — A thin, colorless, or pale-yellowish liquid, 
having the characteristic odor of nutmeg and a warm, spicy taste. It becomes darker 
and thicker by age and exposure to the air. Soluble in an equal volume of alcohol. 
It should be kept in well-stoppered bottles, in a cool place, protected from light. Its 
most important ingredients are pinene, myristol, myristicin, and a phenol. 

Dose. — 1-3 minims (0.06-0 18 Cc.) [3 minims (0.2 Cc), U. S. P.]. 

Physiological Action and Therapeutics are the same as those 
of anise. 

Caryophyllus— Caryophylli— Cloves. U. S. JP. 

Origin. — The dried flower beds of Eugenia aromatica (L. ) O. Kuntze, a hard- 
wood, shrubby evergreen. It was originally found in the Molucca Islands, whence it 
was introduced and cultivated among the East Indian Islands. 

Description and Properties. — The buds are about y% inch (15 Mm.) 
long, dark-brown, consisting of a subcylindrical, solid and glandular calyx-tube, ter- 
minated by four teeth and surmounted by a globular head, formed by four petals 
covering numerous curved stamens, and one style. A clove resembles a nail (L. 
clavus ; Fr. don ) . 

Cloves have a strong aromatic odor and a pungent, spicy taste, and when pressed 
or scratched emit oil. 

Constituents. — Cloves contain about 18 per cent, of a highly pungent volatile 
oil, 17 per cent, of tannin, and small quantities of fixed oil, gum, resin, etc. The 
most important constituent of the oil is the phenol, engenol, C ]0 H ]2 O 2 , making up 70 
to S5 per cent, of the oil, also a terpenene, caryophyllene ; methyl alcohol and fur- 
furol are present in small quantities. 

Dose. — 5-10 grains (0.3-0.6 Gm.) [4 grains (0.25 Gm.), U. S. P.]. 

Official Preparation. 

Tinctura Lavandulae Composita — Tincturae Lavandulae Compositas — Tinc- 
ture of Lavender. — Dose, y z -\ fluidram (2.0-4.0 Cc). (Formula given under 
Lavender. ) 

Oleum Caryophylli— Olei Caryophylli— Oil of Cloves. 

U. S. JP. 

Origin. — A volatile oil distilled from cloves, yielding not less than 80 per cent, by 
volume of eugenol. 

Description and Properties. — A pale-yellow, thin liquid, becoming darker 
and thicker by age and exposure to the air, having a strongly aromatic odor of cloves 
and a pungent, spicy taste. Its specific gravity is 1 .060-1.067. Soluble in an equal 
volume of alcohol, the solution being slightly acid !o litmus-paper. 

Constituents. — Oil of cloves consists of a light and a heavy oil. the former a 
hydrocarbon, supposed to be inactive ; the latter a phenol-like liquid termed engenol. a 
colorless oil with the odor of cloves, a specific gravity of 1. 076-1. 0785, yielding with 
bases crystalline salts. 

Dose. — I-IO minims (0.06-0-6 Cc). 



CONDIMENT GROUP. 345 

Eugenol— Eugenol— Eug-enol. U. S. P. 

Definition. — An unsaturated, aromatic phenol, C 6 H 3 (OH)(OCH 3 ).C 3 H 5 4 : 3 : I, 
obtained from oil of cloves and other sources. 

Description and Properties. — A colorless or pale-yellow, thin liquid, highly 
refractive, and having a strongly aromatic odor of cloves and a pungent, spicy taste. 
Almost insoluble in water, easily soluble in alcohol ; should be soluble in 2 parts of 70 
per cent, alcohol. This is the chief constituent of oil of cloves, and may be used 
instead of the latter ; it is also the chief constituent of oil of pimenta. 

Chemically it is para-oxy-meta-methoxy-allyl-benzol, having the formula: 



HC CH 

I I 
HC COCfL 

\/ 

c 



Ah 



Dose. — Average dose, 3 minims (0.2 Cc), U. S. P. 

Allied Compounds and Derivatives. 

Benzoyl-eugenol. — Origin. — From eugenol. 

Description and Properties. — It occurs in neutral, odorless, colorless, acicular crys- 
tals, having a feebly bitter taste ; soluble in hot alcohol, ether, and chloroform, and 
insoluble in water. 

Dose. — Not yet determined. 

Cinnamyl- eugenol. — Origin. — A derivative of eugenol. 

Description and Properties. — Colorless, odorless, tasteless, lustrous needles, soluble 
in hot alcohol, ether, and chloroform, and insoluble in water. 

Eugenyl-acetamide. — Origin. — Obtained from eugenol-acetic-ethyl-ether by 
treating with solution of ammonia. It occurs as a crystalline powder. 

Physiological Action. — Externally and Locally. — Oil of cloves 
is a counterirritatant, local anesthetic, and germicide. 

Internally. — Its action is essentially the same as that of anise, it 
being a powerful carminative and stimulant. 

Therapeutics. — Externally and Locally. — Oil of cloves is em- 
ployed as a local anesthetic in toothache, earache, and neuralgia, 
and as a synergist to other counterirritants, rubefacients, and anti- 
septics. The eugenol-acetamide is a powerful local anesthetic, 
being analogous to cocaine in its action. 

Internally. — The therapeutics are similar to those of anise. The 
benzoyl-eugenol has been highly recommended by some prac- 
titioners as a valuable remedy in tuberculosis. The following com- 
bination may be employed as an antiseptic and antifermentative in 
gastric fermentation, to be administered either in soft capsules, with 
olive oil as a vehicle, or in the form of an emulsion : 

R 01 ei caryophylli, 
01 ei cinnamomi, 
Olei menfhse piperitee, 
Creosoti, da Tflj.— M. 

Sig. — Take at one time. 

The better way to administer it is in the form of soft capsules, 
each capsule containing the above dose in about 6 minims (0.37 Cc.) 



346 A TEXT-BOOK OF MA TERIA MEDICA. 

of olive oil. One or two capsules should be given three times a 
day, after meals. 

Pimenta— Pimentae— Pimenta. 77. 8. JP. 

(Allspice.) 

Origin. — The dried, nearly ripe fruit of Pimenta officinalis Lindley, an evergreen 
tree about 30 feet (9 M.) high, indigenous in the West Indies, Central America, and 
the northern part of South America. 

Constituents. — The most important constituent is the volatile oil, of which the 
fruit yields from 3 to 4 per cent. 

Oleum Pimenta— Olei Pimentae— Oil of Allspice. 

v. s. r. 

Origin. — A volatile oil distilled from pimenta, yielding not less than 65 per cent. 
by volume of eugenol. 

Description and Properties.— A colorless or pale-yellow liquid, having 
a strong, aromatic, clove-like odor and a pungent, spicy taste. It becomes darker and 
thicker with age and exposure. The active ingredient of the oil is eugenol. 

Dose. — 1-5 minims (0.06-0.3 Cc.) [30 minims (0.2 Cc), U. S. P.]. 

Physiological action and therapeutics are similar to those of 
cloves. 

Zingiber— Zingiberis— Ginger. 77. S. P. 

Origin. — The dry rhizome of Zingiber officinale Roscoe, a perennial herb indige- 
nous in tropical Asia and now cultivated in most tropical countries. 

Description and Properties. — A thick, flattish rhizome from i to 4 inches 
(25 to 100 Mm.) long, with club-shaped lobes on one side ; deprived of the corky 
layer, pale, buff-colored, striate, breaking with a mealy, rather fibrous fracture, showing 
numerous small, scattered resin-cells and fibro- vascular bundles, the latter enclosed by 
a nucleus sheath. Agreeably aromatic and of a warm, pungent taste. 

Ginger contains about 0.75 to 2 per cent, of a pale-yellow volatile oil of uncertain 
composition, to which the ginger owes its aromatic properties ; also a soft resin, giving 
to the drug its hot, pungent taste. The proportion of resin present varies with the 
different varieties of ginger, that from the East Indies yielding about 8 per cent., while 
the Jamaica product yields only about 5 per cent. 

Dose. — 8-30 grains (0.5-2.0 Gm.) [15 grains (1 Gm.), U. S. P.]. 

Official Preparations. 

Fluidextractum Zingiberis — Fluidextracti Zingiberis — Fluidextract of Gin- 
ger. — Dose, 10-30 minims (0.6-2.0 Cc. ) [15 minims (1 Cc), U. S. P.]. 

Oleoresina Zingiberis — Oleoresinae Zingiberis — Oleoresin of Ginger. — Dose, 
1-3 grains (0.06-0.18 Gm.) \_ l / 2 grain (0.03 Gm.), U. S. P.]. 

Pulvis Aromaticus — Pulveris Aromatici — Aromatic Powder. — Dose, 10-30 
grains (0.6-2.0 Gm.) (Formula given under Cardamomtim.) 

Pulvis Rhei Compositus — Pulveris Rhei Compositi — Compound Powder of 
Rhubarb. — Rhubarb, 25 ; magnesia, 65 ; ginger, 10 parts. Dose, }4-l dram (2.O-4.O 
Gm. ) [30 grains (2 Gm.), U. S. P.]. 

Syrupus Zingiberis — Syrupi Zingiberis — Syrup of Ginger. — Dose, %-2 drams 
(2.0-8.0) [4 drams (16 Cc), U. S. P.]. 

Tinctura Zingiberis — Tincturse Zingiberis — Tincture of Ginger (20 per cent.). 
— Dose, y z -z fluidrams (2.0-8.0 Cc.) [30 minims (2 Cc), U. S. P.]. 

Physiological action and therapeutics are almost identical 
with those of other aromatics. Ginger is especially valuable as a 



GROUP OF AROMA TICS. 347 

stomachic and carminative, to stimulate the stomach, improve the 
appetite, and relieve flatulency and colic. It is a safe and efficient 
domestic remedy for the relief of simple diarrhea. It is also much 
used as a corrective to modify the taste and action of other 
medicines. 

IV* GROUP OF AROMATICS USED PARTICULARLY TO 

STIMULATE THE MUCOUS MEMBRANES OF THE 

GENITO-URINARY OR RESPIRATORY TRACTS. 

Buchu— Buchu— Buchu. V. S. JP. 

Origin. — The dried leaves of Barosma beiulina (Thunberg) Bartling et Wend- 
land, a shrub attaining a height of several feet, indigenous in the southern portion of 
Africa, particularly in various parts of Cape Colony. 

Description and Properties. — The leaves are y z to ty inch (12 to 19 Mm.) 
long, roundish-obovate, with rather wedge-shaped base, or varying between oval and 
obovate, crenate or serrate, with a gland at the base of each tooth, dull yellowish- 
green, thickish, pellucid-punctate ; odor and taste strongly aromatic, somewhat mint- 
like, pungent, and bitterish. Buchu contains from I to 2 per cent, of a volatile oil, 
which, on exposure to a low temperature, releases barosma camphor or diosphenol, 
C 10 H 16 O 2 . The bitter principle of buchu is rutin ; resin is also present. 

Dose. — 15-30 grains (1.0-2.0 Gm.) [30 grains (2 Gm. ), U. S. P.]. 

Official Preparation. 

Fluidextractum Buchu — Fluidextracti Buchu — Fluidextract of Buchu. — 
Dose, 15-30 minims (1.0-2.0 Cc.) [30 minims (2 Cc), U. S. P.]. 

Physiological Action and Therapeutics. — Externally and 
locally buchu has no action of importance. When ingested it 
acts as a carminative, in small doses occasioning a feeling of 
warmth, but in excessive doses acting as an irritant. 

Upon the circulation the influence of the drug is that of a mild 
stimulant. 

Its active constituents are rapidly diffused through the blood, 
and are eliminated principally by the kidneys, the bronchial mucous 
membrane sharing in the excretory process. 

Buchu increases the fluid and solid constituents of the urine, 
imparting to it a peculiar aromatic odor. The drug acts as a tonic 
astringent and disinfectant to the mucous membranes, from which 
it is eliminated, diminishing the secretions. 

If taken for too long a period, irritation and inflammation of the 
kidneys are apt to ensue because of excessive stimulation. 

The drug is chiefly employed as a stimulant diuretic and expecto- 
rant in catarrhal conditions of the genito-urinary organs and bron- 
chial tubes. Buchu is therefore of service in urethritis, gonorrhea, 
gleet, chronic cystitis, incontinence of urine due to want of muscular 
tone, pyelitis, etc. The drug has also proved beneficial in certain 
cases of chronic bronchitis, and has even been recommended in 
chronic rheumatism and lithemia. 

Contraindications. — Buchu is contraindicated in acute inflam- 
mation of the kidneys. 



348 A TEXT-BOOK OF MATERIA MEDIC A. 

Administration. — The fluidextract and the infusion are the 
only preparations employed. They should be given freely diluted 
with water. 

Uva Ursi— Uvse Ursi— Uva Ursi. U. S. P. 

(Bearberry.) 

Origin. — The dried leaves of Arctostaphylos Uva Ursi (L.) Sprengel, a trailing- 
evergreen plant distributed throughout the northern portion of North America, extend- 
ing as far south as New Jersey and westward to Colorado. The plant is also found in 
most parts of Europe and in Northern Asia. 

Description and Properties. — Leaves very short-stalked, obovate or oblong- 
spatulate, coriaceous, about f inch (2 Cm.) long and ^ to ^ in.ch (6 to 8 Mm.) wide, 
obtuse, with slightly revolute edges, upper surface with depressed veins, lower sur- 
face distinctly reticulate ; odor faint, hay-like ; taste strongly astringent and somewhat 
bitter. 

Uva ursi contains three glycosides, arbntin, methylarbutin, and ericolin, and a 
tasteless principle, urzone, besides tannic and gallic acids. 

Dose. — 15-60 grains (1.0-4.0 Gm.) [30 grains (2 Gm.), IL S. P.). 

Official Preparation. 

Fluidextractum Uvae Ursi — Fluidextracti Uvae Ursi— Fluidextract of Uva 
Ursi. — Dose, 15-60 minims (1.0-4.0 Cc.) [30 minims (2 Cc.), U. S. P.]. 

The physiological action and therapeutics of uva ursi are 
analogous to those of buchu. The arbutin and methylarbutin are 
capable of being split into glucose and hydrochinon or methyl- 
hydrochinon, to which latter substances the antiseptic action of this 
drug is due. Hence uva ursi is particularly valuable as a urinary 
antiseptic. It is of service in cystitis especially and is a useful drug 
in prostatic hypertrophy to limit urinary infection. 

Juniperus— J uniperi— Juniper. (Non-official.) 

(Juniper Berries.) 

Origin. — The fruit of Juniperis communis (L.), an evergreen tree indigenous in 
the northern hemisphere and found in the United States and Canada and in Europe. 

Description and Properties. — Berries globular, about the size of a large pea, 
externally of a glossy, purplish-black color, covered with a grayish bloom. They have 
an aromatic, balsamic odor, and a sweet terebinthinate, bitterish, and slightly acrid 
taste. Juniper contains a volatile oil ; also juniperin, sugar, wax, fat, etc. 

Dose. — 15-60 grains (1.0-4.0 Gm.). 

Oleum Juniperi— Olei Juniperi— Oil of Juniper. 

U. 8. P. 

Origin. — A volatile oil distilled from the fruit of Juniperus communis. 

Description and Properties. — A colorless or faintly greenish-yellow liquid, 
becoming darker and thicker through age and exposure to air, having the characteristic 
odor of juniper and a warm, aromatic, somewhat terebinthinate and bitterish taste. 
Soluble in about four times its volume of alcohol, forming a more or less turbid liquid, 
which is neutral or slightly acid to litmus-paper. 

Dose. — 5-15 minims (0.3-1.0 Cc.) [30 minims (0.2 Cc), U. S. P.]. 



GROUP OF AROMA TICS. 349 

Official Preparations. 

Spiritus Juniperi — Spiritus Juniperi — Spirit of Juniper. — Dose, 1-8 fluidrams 
(4.0-30.0 Cc). Formula: Oil of juniper, 5; alcohol, 95 parts [30 minims (2C0, 
U. S. P.]. 

Spiritus Juniperi Compositus — Spiritus Juniperi Compositi — Compound 
Spirit of Juniper. — Formula : Oil of juniper, 8 ; oil of caraway, I ; oil of fennel, I ; 
alcohol, 1700; water sufficient to make 2000 parts.— Dose, 2-4 fluidrams (8.0-15.0 
Cc.) [2 fluidrams (5 Cc), U. S. P.]. 

Physiological Action and Therapeutics. — Juniper in its action 
resembles buchu, being a stimulant diuretic. Under certain condi- 
tions it acts as a diaphoretic. It is a tonic to the stomach and a 
mild aphrodisiac. 

The volatile oil, which is the active constituent of juniper, 
diffuses through the blood with great facility, stimulating the heart, 
and, in dropsical conditions, increasing the flow of urine. In 
health, however, the amount of urine is diminished, while that of 
urea is augmented. 

Juniper is used for the same purposes as buchu — being superior 
to the latter drug perhaps — especially in various dropsies and 
passive congestion of the kidneys. 

Contraindications. — The same as for buchu. 

Administration. — Any of the preparations may be given, gin 
being a popular diuretic. 

Copaiba— Copaibae— Copaiba. U. S. JP. 

(Balsam of Copaiba.) 

Definition. — An oleoresin derived from one or more South American species of 
Copaiba. 

Description and Properties. — A transparent or translucent, more or less 
viscid liquid of a pale-yellow to brownish-yellow color, having a peculiar aromatic odor 
and a bitter, acrid taste. Insoluble in water ; readily soluble in absolute alcohol, ether, 
chloroform, carbon disulphide, benzin, and fixed and volatile oils. 

Copaiba contains a volatile oil. two resins, copaibic acid (soluble in absolute alcohol 
and in ammonia), and a bitter principle. 

Dose. — 5-30 minims (0.3-2.0 Cc. ) [15 minims (1 Cc), U. S. P.] in emulsion or 
capsule. 

Oleum Copaibae— Olei Copaibae— Oil of Copaiba. 

77. 8. JP. 

Origin. — A volatile oil distilled from copaiba. 

Description and Properties. — A colorless or pale-yellowish liquid, having 
the characteristic odor of copaiba and an aromatic, bitterish, and a pungent taste. 
Soluble in about ten times its volume of alcohol, forming a slightly turbid liquid, which 
is neutral to litmus-paper. The drug should be kept in well-stoppered bottles, in a 
cool place. Caryophyllene is an important constituent of the oil. 

Dose. — 5-15 minims (0.3-1.0 Cc. ) [8 minims (5 Cc), U. S. P.]. 

Antagonists and Incompatibles. — Copaiba is antagonized by 
the same drugs which antagonize turpentine. It is pharmaceuti- 
cally incompatible with aqueous preparations. 

Synergists. — The same as for turpentine. 



350 A TEXT-BOOK OF MA TERIA MEDICA. 

Physiological Action. — Externally and Locally. — Copaiba has 
no influence of importance, being but slightly stimulant to the skin. 

Internally. — Digestive System. — Its action is analogous to that 
of turpentine and the volatile oils. The ingestion of the drug, 
even in small doses, is almost always succeeded by eructations 
tasting of copaiba. 

Copaiba exerts no special influence upon the circulatory, ner- 
vous, and respiratory systems. 

Absorptio7i and Elimination. — The drug enters the circulation 
with facility, and is slowly eliminated by the skin and mucous 
membranes generally, although chiefly by the kidneys. The resin 
which the drug contains is a powerful stimulant of the genito- 
urinary structures, increasing the quantity, and to some extent the 
solid constituents, of the urine. Large doses irritate the kidneys, 
occasionally producing strangury, bloody urine, pain in the blad- 
der, etc. 

Under the use of copaiba albumin is sometimes found in the 
urine. Frequently the nitric-acid test with urine may give a reac- 
tion as if for albumin, the conclusions being then erroneous, since 
the resin of copaiba eliminated in the urine is by the action of 
nitric acid precipitated as a milky cloud, readily differentiated from 
albumin by heating the urine or mixing it with alcohol, by both of 
which means the resinous precipitate is dissolved. 

Copaiba acts as a stimulant and disinfectant at the points of 
elimination, in medicinal amounts increasing secretion and imparting 
to the secretion from the kidneys, bronchial mucous membrane, and 
skin a peculiar, fragrant odor. 

Untoward Action. — It often happens that after a few days' ad- 
ministration of copaiba there is produced in certain individuals an 
eruption, usually resembling roseola, which later may be trans- 
formed into true papules ; or the eruption may be scarlatiniform 
in character, or a true eczema ensue. These eruptions are first 
noticeable on the upper and lower extremities, backs of the hands 
and knees, malleoli, etc., and are attended with intense itching. 

Under the prolonged use of the drug there may occur serious 
disturbances of the digestive and genito-urinary tracts. 

Poisoning. — In addition to the untoward manifestations already 
mentioned, very large doses of copaiba produce symptoms similar 
to those described under Turpentine. Cases have been recorded 
in which excessive amounts occasioned paralysis and tetanoid 
attacks. 

Treatment of Poisoning. — This should be the same as prescribed 
under Turpentine. 

Therapeutics. — Externally and Locally. — Copaiba is of value 
in chronic diseases of the skin, such as psoriasis, lupus, etc. The 
drug has proved valuable in frost-bites. 

Internally. — The principal use of copaiba is as a stimulant and 
disinfectant of the genito-urinaiy tract in cases of gleet, subacute 
gonorrhea, vaginitis, cystitis, pyelitis, etc. 



GROUP OF AROMA TICS. 351 

In ascites and dropsical conditions, particularly those due to 
hepatic and cardiac diseases, the resin of copaiba proves a very 
efficient and reliable diuretic. Under prolonged use, however, a 
tolerance appears to be established. 

Copaiba is a valuable remedy in chronic bronchitis and bron- 
chorrJiea with offensive expectoration. 

The drug has been at times given internally with good results 
in psoriasis, iirticaria, etc., although the internal use of copaiba in 
these disorders is less common than formerly. 

The drug has found enthusiastic advocates as a remedy in 
chronic diarrhea and dysentery, and has also been recommended in 
chronic proctitis and chronic intestinal catarrh. 

Contraindications. — The same as for turpentine. 

Administration. — The methods of administration recommended 
for turpentine are applicable to this drug. It is claimed that many 
of the untoward manifestations produced by copaiba may be pre- 
vented by giving the drug with an alkali. With this object in view, 
in the Pharmacopoeia of 1 890 copaiba was associated with magnesia 
in the " Massa Copaibse." Yet, while this preparation is perhaps 
less likely to produce untoward results, it is undoubtedly less active 
therapeutically than the single drug. 

Oleum Santali— Olei Santali— Oil of Santal. 

77. S. P. 

(Oil of Sandalwood.) 

Origin. — A volatile oil distilled from the wood of Santalum album L., yielding 
not less than 90 per cent, of alcohols calculated as santalol. Santalum album is a 
small tree indigenous in Southern India and portions of the East Indies. 

Description and Properties. — A pale-yellowish or yellow, somewhat thick- 
ish liquid, having a peculiar, strongly aromatic odor and a pungent, spicy taste; readily 
soluble in alcohol. It is frequently adulterated with oil of cedar. 

Dose. — 5-20 minims (0.3-1.2 Cc.) [8 minims (0.5 Cc), U. S. P.]. 

Physiological Action and Therapeutics. — The action of oil of 
sandalwood resembles closely that of copaiba, and it may be given 
for the same purposes as the latter drug, although oil of sandal- 
wood is more popular, and ordinarily a more efficient, remedy for 
gonorrhea, particularly in the early stages. Sandalwood oil is one 
of the mildest of the genito-urinary stimulants. It is very fre- 
quently adulterated with a worthless oil of cedar. 

Administration. — The same as in the case of copaiba. 

Cubeba— Cubebae— Cubeb. 77. 8. B. 

Origin. — The dried, unripe, but fully grown fruit of Piper Cubeba Linn, fil., a 
climbing dioecious shrub about 20 feet (6 M.) high, indigenous in Java. 

Description and Properties. — Globular, about \ or \ inch (4 or 5 Mm. ) in 
diameter, contracted at the base into a rounded stipe about \ or § inch (6 or 10 Mm. ) 
long, reticulately wrinkled, blackish-gray, internally whitish and hollow; odor strong, 
spicy ; taste aromatic and pungent. It contains from 5 to 15 per cent, of a volatile oil, 
an odorous principle, cubebin, and a diuretic principle, cubebic acid, besides resin, fat s 
wax, and starch. 

Dose. — 5-60 grains (0.32-4.0 Gm. ) [15 grains (1 Gm.), U. S. P.]. 



352 A TEXT-BOOK OF MATERIA MEDICA. 

Official Preparations. 

Fluidextractum Cubebae — Fluidextracti Cubebae — Fluidextract of Cubeb. — 
Dose, 5-60 minims (0.32-4.0 Cc. | [15 minims (1 Cc. ), U. S. P.]. 

Oleoresina Cubebae— Oleoresinse Cubebae — Oleoresin of Cubeb. — Dose, 15- 
30 minims (0.32-2.0 Cc. ) \j l / 2 grains (0.5 Gm.), U. S. P.]. 

Trochisci Cubebae — Trochiscos (ace.) Cubebae — Troches of Cubeb. — (Each 
troche contains ^ minim (0.02 Cc. ) of the oleoresin.) Dose, 1-6 troches. 

Oleum Cubebae— Olei Cubebae— Oil of Cubeb. 

U. S. JP. 

Origin. — A volatile oil distilled from cubeb. 

Description and Properties.— A colorless, pale-greenish, or yellowish liquid, 
having the characteristic odor of cubeb and a warm, camphoraceous, aromatic taste. 
Soluble in an equal volume of alcohol. It should be kept in well-stoppered botdes, in 
a cool place, protected from light. 

Dose.— 5-15 minims (0.3-1.0 Cc.) [8 minims (0.5 Cc), L. S. P.]. 

Synergists. — Buchu, copaiba, oil of santal, black pepper, and 
many of the aromatic and volatile oils. 

Physiological Action. — Externally and Locally. — Like the 
aromatics and drugs containing a volatile oil, cubeb is irritant and 
rubefacient when applied by inunction. 

Internally. — Digestive System. — In medicinal amounts cubeb is 
an aromatic stomachic, increasing the appetite and improving diges- 
tion. As is the case with other drugs of this class, large dosage 
or the too prolonged use of small amounts irritates the stomach 
and deranges digestion, cubeb acting as a laxative and occasioning 
a sensation of heat and discomfort about the rectum. 

Internally it has the general action of the volatile oil series. 

Absorption and Elimination. — Cubeb is absorbed and eliminated 
with considerable rapidity. It escapes from the body chiefly by 
the urine, though the skin and bronchial mucous membrane share 
in the excretory process. The drug acts as an active stimulant 
and disinfectant to the structures by which it is excreted, and is 
consequently a diuretic, expectorant, and mild diaphoretic. 

The urine and the amount of uric acid are increased by cubeb, 
the drug appearing in the urine as a salt of cubebic acid, which 
may be precipitated by nitric acid, the precipitate resembling that 
of albumin. 

Untoward Action. — Cubeb occasionally produces great disturb- 
ance in the gastro-intestinal tract, colicky pains, and diarrhea. 
The most frequent untoward manifestations, however, are various 
cutaneous eruptions, appearing in the form of papules, and often- 
times as a diffuse erythema. No febrile symptoms attend these 
eruptions, which usually disappear shortly after the suspension of 
the drug. 

Poisoning. — Although cubeb is not regarded as a poison, very 
large doses may be followed by all the symptoms of severe gastro- 
intestinal irritation. 

Treatment of Poisoning. — The indications are to empty the 



GRO UP OF AROMA TICS. 353 

stomach, favor elimination, and treat the patient symptomatically 
by the use of demulcents, anodynes, stimulants, etc., as necessary. 

Therapeutics. — Exter?ially and Locally. — The drug is a de- 
servedly popular remedy in many diseases of the nose and throat. 
The insufflation of an impalpable powder of cubeb or the inhala- 
tion of smoke from the burning drug is an efficient palliative to the 
sense of oppression arising from turgescence of the nasal mucous 
membrane. 

The troches of cubeb are extensively used for coughs, hoarse- 
ness, etc. The oil of cubeb is used as an inhalant and as a local 
application in many diseases of the throat and respiratory passages. 

Internally. — Cubeb is used internally for about the same pur- 
poses as copaiba, although by many physicians considered to be 
inferior to the latter drug in genito-urinary disorders. 

Contraindications. — The same as for copaiba. 

Administration. — Any of the preparations may be given. The 
oleoresin is best administered in capsules or emulsion. 

Grindelia— Grindeliae— Grindelia. U. S. JP. 

Origin. — The dried leaves and flowering tops of Grindelia robusta Nutt., and of 
Grindelia squarrosa Dunal, herbaceous or suffruticose perennials, indigenous in the 
western part of North America and Mexico. 

Description and Properties. — Leaves about 2 inches (5 Cm.) long, varying 
from broadly spatulate or oblong to lanceolate, sessile or clasping, obtuse, more or less 
sharply serrate, often spinous-toothed or even laciniate-pinnatifid, pale-green, smooth, 
finely dotted, thickish, brittle ; heads many-flowered, subglobular or somewhat conical, 
the involucre hemispherical, about ^ inch (10 Mm.) broad, composed of numerous 
imbricated, squarrose-tipped, or spreading scales ; ray-florets yellow, ligulate, pistillate ; 
disk-florets yellow, tubular, perfect ; pappus consisting of two or three awns of the 
length of the disk-florets ; odor balsamic ; taste pungently aromatic and bitter. 

The principal constituent is probably a resinous substance. It also contains an 
alkaloid principle, grindeline, and a volatile and a fixed oil. 

Dose. — 10-60 grains (0.6-4.0 Gm.) [30 grains (2 Gm.), U. S. P.]. 

Official Preparation. 

Fluidextractum Grindeliae — Fluidextracti Grindeliae — Fluidextract of Grin- 
delia. — Dose, 10-60 minims (0.6-3.7 Cc.) [30 minims (2 Cc. ), U. S. P.J. 

Antagonists and Incompatibles. — Aqueous preparations, the 
caustic alkalies, and mineral salts are incompatible. 

Synergists. — The motor depressants. 

Physiological Action. — Externally and Locally. — The drug is 
sedative and mildly astringent. 

Internally. — Digestive System. — When ingested it excites a sense 
of warmth in the epigastrium, and in moderate doses increases the 
secretion of the gastric juice, stimulating the appetite and improv- 
ing digestion. 

Nervous System. — Grindelia possesses considerable power as a 
depressant. Its effect upon the motor mechanism is to cause a pro- 
nounced muscular weakness affecting first the lower extremities. 
The sensory nerves are first depressed, there being quite marked 



354 A TEXT-BOOK OF MATERIA MEDICA. 

cutaneous anesthesia. The drug depresses the reflex mechanism 
in the spinal cord, so that the reflex movements are greatly less- 
ened. 

Circulatory System. — The heart is slowed by medicinal doses 
through stimulation of the inhibitory center. The blood-pressure, 
however, is raised and maintained by stimulation of the vasomotor 
center. 

Respiratory System. — Small doses have little effect upon the 
respiratory movements ; large doses retard the breathing ; while 
toxic doses may produce death through paralysis of the respiratory 
muscles. 

The drug slightly increases the secretion from the pulmonary 
mucous membrane and relaxes the circular fibers of the bronchial 
muscles. The ends of the sensory nerves distributed to the pul- 
monary mucous membrane are also depressed. 

Absorption and Elimination. — Grindelia is readily absorbed, and 
is eliminated chiefly by the kidneys, increasing the urinary flow, 
the lungs sharing in the excretory process. 

Temperature is unaffected. 

Eye. — Large doses cause dilatation of the pupil. 

Uterus. — No effect has been noticed. 

Untoward Action. — Excepting drowsiness, reduction of cutane- 
ous sensibility, slight gastric disturbance, and a feeling of weakness, 
no symptoms have been recorded. 

Poisoning. — The drug is feebly toxic ; excessive doses, how- 
ever, act as a gastro-intestinal irritant. The patient is sleepy and 
complains of muscular weakness ; there is a numb or anesthetic 
condition of the skin, while the pupils are dilated and the pulse and 
respiratory movements slow and feeble. Should death occur, it 
will be from paralysis of the muscles of respiration. 

Treatment of Poisoning. — The same as in poisoning from conium 
— diffusible stimulants, strychnine, etc. 

Therapeutics. — Externally and Locally. — Grindelia is a very 
efficient application to the skin in rhus-poisoning. Indeed, it serves 
as a soothing lotion in many acute inflammations of the skin, such 
as eczema, etc. The fluidextract used should be well diluted and 
applied on cloths. 

Internally. — Grindelia has acquired an enviable reputation as a 
remedy for spasmodic asthma, its action upon the bronchial muscles 
rendering it singularly beneficial in this disorder. It acts to relax 
the spasm of the muscles. The drug has no influence, however, 
in preventing a recurrence of the paroxysms. 

The drug has been highly recommended in acute and chronic 
bronchitis, hay-fever, whooping-cough, and in spasmodic cough of 
whatever nature. It has even been suggested as a palliative remedy 
in pneumonia and in cardiac and pulmonary dyspnea. 

There arc no special contraindications or directions for ad- 
ministration, save that the fluidextract is pharmaceutically incom- 
patible with aqueous preparations. 



GRO UP OF AROMA TICS. 355 

Balsamum Peruvianum— Balsami Peruviani— 
Balsam of Peru. U. S. J\ 

Origin. — A balsam obtained from Toluifera Pareirce (Royale) Baillon, a tree 
growing in Brazil and near the west coast of South America. 

Description and Properties. — A liquid having a syrupy consistence, free 
from stringency or stickiness, of a brownish-black color in bulk, reddish brown and 
transparent in thin layers, of an agreeable, vanilla-like, somewhat smoky odor, and a 
bitter tase, leaving a persistent after-taste. On exposure to air it does not become hard. 
It is completely soluble in 5 parts of alcohol. 

The drug contains, among other substances, benzoic and cinnamic acid, cinnamein 
about 60 per cent., and resin 32 per cent. 

Dose.— 8-30 minims (0.5-1.84 Cc.) [15 grains (1 Gm.), U. S. P.]. 

Physiological Action. — Its physiological action is largely due 
to the aromatic acids, cinnamic, and benzoic acids contained. See 
Benzoin. 

Therapeutics. — In various cutaneous disorders balsam of Peru 
is very efficient, being employed in pruritus vulvae, eczema, scabies, 
ringworm, etc. It is remarkably efficacious as an application to 
cracked nipples, cracked lips, indolent sores, bed-sores, etc., and is 
also serviceable in certain diseased conditions of the nose and 
throat, such as atrophic rhinitis and tonsillar diphtheria. 

As a stimulant expectorant the drug is efficient in chronic bron- 
chitis, being regarded by some physicians as of great service in 
phthisis pulmonalis. — Like myrrh, balsam of Peru has been used 
to some extent as a stomachic carminative and tonic. 

Administration. — It is best given in an emulsion or in glycerin. 

Balsamum Tolutanum— Balsami Tolutani— Balsam 
of Tolu. IT. S. P. 

Origin. — A balsam obtained from Toluifera Balsamum L., an evergreen tree 
from 60 to 80 feet (18-24 M nigh, growing in the high rolling country of Venezuela 
and New Granada. 

Description and Properties. — A yellowish-brown, semifluid, or nearly solid 
mass, becoming more brittle when exposed to cold ; transparent in thin layers, having 
an agreeable odor, recalling that of vanilla, but distinct from it, and a mild, aromatic 
taste ; readily and completely soluble in alcohol, chloroform, and solutions of the fixed 
alkalies; almost wholly soluble in ether, but nearly insoluble in water or carbon 
disulphide. 

The drug contains a volatile oil (chiefly toluene), cinnamic and benzoic acids, and 
a resin. 

Dose. — 8-30 minims (0.5-2.0 Cc.) [15 grains (1 Gm.), U. S. P.]. 

Official Preparations. 

Syrupus Tolutanus— Syrupi Tolutani— Syrup of Tolu (0.5 percent.). — Dose, 
2-6 fluidrams (8.0-24.0 Cc.) [4 fluidrams (16 Cc), U. S. P.]. 

Tinctura Tolutana — Tincturae Tolutanae — Tincture of Tolu (20 per cent.). 
— Dose, y z -2. fluidrams (2.0-8.0 Cc. ) [30 minims (2 Cc), U. S. P.].^ 

Tinctura Benzoini Composita — Tincturae Benzoini Compositae — Compound 
Tincture of Benzoin (4 per cent.). — Described under Benzoin. 

Antagonists and Incompatibles. — Aqueous preparations are 
pharmaceutically incompatible with the tincture of tolu. 



356 A TEXT-BOOK OF MATERIA MEDICA. 

Synergists. — The balsams, aromatic drugs, volatile oils, and 
stimulant expectorants. 

Physiological Action. — Balsam of tolu is antiseptic, disinfect- 
ant, and stimulant when applied to the skin and to raw surfaces. 
It is a pleasant carminative and stomachic. 

The drug is excreted principally by the mucous membranes, the 
secretions from which it stimulates and disinfects. The skin and 
kidneys also share in the excretory process. 

Therapeutics. — Inhalations of the vapor of tolu have been suc- 
cessfully employed in the treatment of chronic pharyngitis, and a 
pigment composed of I part of tolu to 5 parts of ether or alcohol 
has been beneficially applied to diphtheritic deposits on the tonsils 
and pharynx. 

Its agreeable flavor, together with its stimulating and expecto- 
rant properties, renders tolu an efficient and agreeable ingredient 
of cough mixtures, lozenges, vapors, etc., employed to modify the 
course of subacute and chronic bronchitis. 

Administration. — Tolu is usually administered in the form of 
syrup, although the tincture may be given in emulsion. Inhala- 
tions of tolu vapor are employed, and lozenges containing tolu are 
frequently used. 

Pix Liquida— Picis Liquidae— Tar. 77. S. JP. 

Definition. — A product obtained by the destructive distillation of the wood of 
Pinus palustris Miller, and other species of Pinus. 

Description and Properties.— Thick, viscid, semifluid, blackish-brown, 
heavier than water, transparent in thin layers, becoming granular and opaque with 
age ; odor empyreumatic, terebinthinate ; taste sharp, empyreumatic. Tar is slightly 
soluble in water ; soluble in alcohol, fixed and volatile oils, and solution of potassium 
or sodium hydrate. 

The drug contains many substances, chief among which are empyreumatic vola- 
tile oil, pyrocatechin, acetone, xylol, toluol, cresols (creasote), guaiacol, phenol, etc. 

Dose. — 15-60 grains (1.0-4.0 Gm. ) [jh grains (0.5 Gm.), U. S. P.]. 

Official Preparations. 

Syrupus Picis Liquidse — Syrupi Picis Liquidae — Syrup of Tar (0.5 per cent.). 
— Dose, 1-4 fluidrams (40-15 oCc.) [1 dram (4 Cc), U. S. P.], 

Unguentum Picis Liquidae — Unguenti Picis Liquidae — Tar Ointment (50 
per cent.). Used externally. 

Oleum Picis Liquidae — Olei Picis Liquidae— Oil of Tar (U. S. P.). — Origin. 
— A volatile oil distilled from tar. 

Description and Properties. — An almost odorless liquid when freshly distilled, but 
soon acquiring a dark reddish-brown color and having a strong tarry odor and taste. 
It is readily soluble in alcohol. 

Dose. — 1-5 minims (0.065-0.3 Cc). 

Derivatives and Allied Drugs. 

Pixol. — A compound of tar soap and caustic potash or soda. Used as a disinfect- 
ant and antiseptic. 

Pix Betulae— Picis Betulae— Birch Tar (Oleum Rusci). — Origin.— Prepared 
in Russia from the wood and bark of Betula alba L. 

Description and Properties. — Resembling wood-tar in appearance, but remaining 
liquid, and having the peculiar penetrating odor of Russia leather, in the manufacture 
of which it is used. For the most part employed externally. 



GROUP OF AROMA TICS. 357 

Oleum Cadinum— Olei Cadini — Oil of Cade (U. S. P.). — Origin. — A product 
of the dry distillation of the wood of Juniperus Oxycedrus L. 

Description and Properties, — An empyreumatic, brownish or dark-brown, clear, 
thick liquid, possessing a tarry odor and an empyreumatic, burning, somewhat bitter 
taste. Almost insoluble in water ; partially soluble in alcohol. 

Dose, — 2-6 minims (0.12-0.3 Cc). Chiefly used externally. 

Antagonists and Incompatibles. — There are none of special 
importance. 

Synergists. — The aromatics, carbolic acid, creasote, and many 
of the antiseptics, turpentine, and the stimulant expectorants. 

Physiological Action. — Externally and Locally. — Tar is a stim- 
ulant, astringent, antipruritic, antiseptic, and parasiticide. It is 
readily absorbed from the skin, and when applied too freely may 
produce a papular eruption. 

Internally. — The action of tar closely resembles that of turpen- 
tine, although creosote is perhaps a more perfect analogue. Small 
doses stimulate the circulation and increase secretions generally. 
Immoderate dosage or the prolonged administration of tar impairs 
the appetite, deranges digestion, and depresses the circulatory and 
nervous systems. 

While the drug is not considered poisonous, the ingestion of 
excessive quantities of oil of tar has been attended with fatal results. 
The symptoms following imprudent dosage are nausea, vomiting, 
severe abdominal pain, diarrhea, headache, and dizziness. The 
urine is colored blackish-brown, and may contain blood or albumin 
and emit the peculiar odor of tar. There may be present erythema, 
or the skin may be covered with papules or vesicles attended with 
intense itching. 

Therapeutics. — Externally and Locally. — With the possible 
exception of sulphur and mercury, tar is the most universally 
employed remedy for cutaneous diseases, the drug having for cen- 
turies held an important place among the efficient topical agents 
in the treatment of diseases of the skin, unhealthy ulcers, fissured 
nipples, boils, excoriations, etc. 

In chronic eczema the drug is peculiarly servicable, and it has 
proved beneficial in chronic psoriasis and scabies. 

The oil of cade and oil of birch are used for the same pur- 
poses as tar, being preferred by some expert dermatologists. The 
tarry preparations are valuable antipruritics, and of service in 
pruritus and various itching diseases of the skin, although their 
tendency to produce irritative and inflammatory effects when con- 
tinuously and injudiciously applied should not be overlooked. 

The benign and emollient effects of tar are best obtained when 
the drug is mixed with some soothing or astringent powder, such 
as chalk. 

The valuable properties of tar in the treatment of cutaneous 
diseases are often nullified by the ignorance of the physician and 
lack of proper administration of the drug. Prof. James Nevins 
Hyde has truthfully observed that " the skill of a physician 



358 A TEXT-BOOK OF MATERIA MEDIC A. 

entrusted with the management of a disease of the skin might also 
be measured by his success in the use of tar." 

Lozenges containing tar, the vapor of oil of tar, and sprays 
containing tar are extensively employed in the treatment of various 
diseases of the nose and throat. 

Internally. — Tar has long possessed an enviable reputation as 
a remedy for chronic pulmonary complaints, being very efficient 
in the treatment of chronic bronchitis and the advanced stages of 
obstinate acute bronchitis, lessening the expectoration, allaying the 
oppression and distress in the chest, and soothing the cough. These 
symptoms, which attend many cases of pulmonary phthisis, are fre- 
quently relieved by some preparation of tar. 

Not only is this remedy of value in catarrhal conditions of the 
respiratory passages ; it is equally efficient in similar conditions of 
mucous membranes elsewhere. Thus tar water has been 
employed with great benefit in gleet, leukorrhea, vesical catarrh, etc., 
being given both by the mouth and in the form of an injection. 

Administration. — Tar may be given in milk or beer or in pill 
form, although the most palatable forms are the syrup, glycerite, 
wine, and tar water, the last of which may be given to the extent 
of I or 2 pints (473.17 or 946.35 Cc.) daily. 



Sabal— Sabal— Sabal. U. S. P. 

Definition. — The partially dried ripe fruit of Serenoa serrulata, commonly known 
as saw palmetto. 

Very little is known concerning the active principles of saw palmetto. A volatile 
oil, a fixed oil, a fat, an alkaloid, a resin, dextrin, and glucose have been isolated. 

Dose. — Average dose, 15 grains (1 Gm.), U. S. P. 

Physiological Action. — The oil of saw palmetto is thought to 
act in a manner similar to the oils of sandal, copaiba, etc. 

Therapeutics. — It is useful in the chronic stages of gleet and in 
the cystitis of hypertrophied prostate. 



V, AROMATICS USED FOR THEIR SUPPOSED ANTI- 
SPASMODIC ACTION ON THE NERVOUS SYSTEM. 

Asafoetida— Asafoetidae— Asafetida. U. S. IP. 

Origin. — A gum-resin obtained from the root of Ferula foetida (Bunge) Regel, 
and probably other species of Ferula, large perennial herbs found in Turkestan, Western 
Thibet, and Western Afghanistan. 

Description and Properties. — Irregular masses composed of whitish tears 
embedded in a yellowish- or brownish-gray, sticky mass. The tears when hard break 
with a conchoidal fracture, showing a milk-white color, which changes, on exposure, to 
pink, and finally to brown. The drug has a persistent alliaceous odor and a bitter, 
alliaceous, acrid taste. When triturated with water it yields a milk-white emulsion, 
which becomes yellow upon the addition of ammonia water. It is partly soluble in 
ether, and at least 60 per cent, of it should dissolve in alcohol. 

Dose. — 5-8 grains ( 0.3-0.5 Gm.) [4 grains (2.5 Gm.), U. S. P.]. 



ANTISPASMODIC AROMA TICS. 359 

Official Preparations. 

Emulsum Asafoetidae— Emulsi Asafoetidae— Emulsion of Asafetida.— £W, 
2-4fluidrams (7-39- r 5 Cc.} [4 fluidrams (16 Cc.) U. S. P.J. 

Pilulae Asafoetidae— Pilulas (ace.) Asafoetidae— Pills of Asafetida.— Dose, 
2 to 5 pills. 

Tinctura Asafoetidae— Tincturae Asafoetidae— Tincture of Asafetida (20 
per cent.).— Dose, 10-40 minims (0.6-2.5 Cc.) [15 minims (1 Cc.) U. S. P.]. 

Camphora— Camphorae-Camphor. U. S. P. 

Definition.— The dextrogyrate modification of the saturated ketone, C 9 H 16 CO, 
obtained from Cinnamomum camphora (L.) Nees et Ebermaier, and purified by subli- 
mation. 

The camphor laurel is a handsome tree 25 to 30 feet (7.5-9 M. ) high, indigenous in 
Eastern and Southeastern Asia, and -cultivated in Italy as an ornamental tree. 

Description and Properties.— White, translucent masses, of a tough consist- 
ence and crystalline structure, readily pulverizable in the presence of a little alcohol, 
ether, or chloroform ; having a penetrating, characteristic odor and a pungently aromatic 
taste. Very sparingly soluble in water, but readily soluble in alcohol, ether, chloroform, 
carbon disulphide, benzin, and in fixed and volatile oils. 

When camphor is triturated in about molecular proportions with menthol, thymol, 
phenol, or chloral hydrate, liquefaction ensues. It melts at 175 C. (347 F.), boils at 
204 C. (399. 2° F.), and is inflammable, burning with a luminous, smoky flame. On ex- 
posure to the air it evaporates more or less rapidly at ordinary temperatures, and when 
moderately heated it sublimes without leaving a residue. 

From camphor may be obtained a number of interesting compounds, such as cam- 
phoric acid, cymol, etc. The drug should be kept in well-closed vessels, in a cool place. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 



Official Preparations. 

Aqua Camphorae — Aquae Camphorae — Camphor Water (0.8 per cent.). — 
Dose, %-2 fluidounces (15. 0-30.0 Cc.) [2 fluidrams (8 Cc.) U. S. P.]. 

Linimentum Camphorae — Linimenti Camphorae — Camphor Liniment. — 
Camphor, 20 ; cottonseed oil, 80 parts. For external use. 

Linimentum Saponis — Linimenti Saponis — Soap Liniment (4-5 per cent.). — 
For external use. 

Spiritus Camphorae — Spiritus Camphorae — Spirit of Camphor (10 per cent.). 
— Dose, 5-40 minims (0.3-2.9 Cc.) [15 minims (1 Cc), U. S. P.]. 

Tinctura Opii Camphorata — Tincturae Opii Camphoratae — Camphorated 
Tincture of Opium (0.4 per cent.). — Dose, 1-4 fluidrams (4-15 Cc), [2 fluidrams 
(8Cc.) U. S. P.]. 

Camphora Monobromata — Camphorae Monobromatae — Monobromated 
Camphor (U. S. P.). — Definition. — A substitution compound of camphor, C 9 H 15 BrCO. 

Origin. — Prepared by heating camphor and bromine, dissolving in benzin, and 
crystallizing from hot alcohol. 

Description and Properties. — Colorless, prismatic needles or scales, of a mild, cam- 
phoraceous odor and taste, permanent in the air, unaffected by light, and neutral to litmus- 
paper. Almost insoluble in water ; freely soluble in alcohol, ether, chloroform, hot 
benzin, and fixed and volatile oils ; slightly soluble in glycerin. 

Dose. — 2-5 grains (0.12-0.3 Gm. ) [2 grains (.125 Gm.), U. S. P.]. 

Acidum Camphoricum — Acidi Camphorici — Camphoric Acid (U. S. P.). — 
Definition. — A dibasic organic acid, C 8 H 14 (COOH) 2 , obtained by the oxidation of 
camphor. 

Origin. — Obtained by the oxidation of camphor through the action of nitric acid. 
Description and Properties. — White, acicular crystals, odorless, and of a weak, acid, 
and slightly astringent taste. Soluble in hot water, alcohol, ether, and fatty oils ; almost 
insoluble in cold water. 

Dose. — 10-30 grains (0.6-2.0 Gm.) [15 grains (i Gm.), U. S. P.]. 



360 A TEXT-BOOK OF MATERIA MEDICA. 

Valeriana— Valerianae— Valerian. U. S. P. 

Origin. — The dried rhizome and roots of Valeriana officinalis L., an herbaceous 
perennial 2 to 4 feet (0.6-1.2 M. ) high, a native of Europe, and cultivated to some extent 
in New England and New York. 

Description and Properties. — The rhizome varies in length between y z 
and 1^ inches (1-3 Cm.), and has nearly an equal diameter, thick, upright, subglobu- 
lar or obconical, truncate at both ends, brown or yellowish-brown, internally whitish or 
pale-brownish, with a narrow circle of white wood under the thin bark. Roots numer- 
ous, slender, brittle, brown, with a thick bark and slender, ligneous cord. Odor 
peculiar, becoming stronger and unpleasant on keeping ; taste camphoraceous and some- 
what bitter. 

Valerian contains valerianic and other acids and a volatile oil. 

Dose. — 15-60 grains (1.0-4.0 Gm.) [30 grains (2 Gm.), U. S. P.]. 

Official Preparations. 

Fluidextractum Valerianae — Fluidextracti Valerianae — Fluidextract of Va- 
lerian. — Dose, 15-60 minims (1.0-4.0 Cc.) [30 minims (2 Cc), U. S. P.]. 

Tinctura Valerianae — Tincturae Valerianae — Tincture of Valerian (20 per 
cent.). — Dose, 1-2 fiuidrams (4.0-8.0 Cc). [1 fluidram (4CC.), U. S. P.]. 

Tinctura Valerianae Ammoniata — Tincturae Valerianae Ammoniatae — Ara- 
moniated Tincture of Valerian (20 per cent.). — Dose, 30-60 minims (2.0-4.0 Cc.) 
[30 minims (2 Cc), U. S. P.]. 

Ammonii Valeras — Ammonii Valeratis — Ammonium Valerate (U. S. P.). — 
Definition. — It should contain not less than 98 per cent, of pure ammonium valerate, 
C 4 H 9 COONH 4 . 

Origin. — Obtained by saturating valerianic acid with gaseous ammonia and crys- 
tallizing. 

Description and Properties. — Colorless or white quadrangular plates, emitting the 
odor of valerianic acid ; of a sharp and sweetish taste ; deliquescent in moist air. Very 
soluble in water and in alcohol. Ammonium valerianate should be kept in well- 
stoppered bottles. 

Dose. — 2-10 grains (o 12-6 Gm.), [7 J grains (5 Gm.) U. S. P.]. 

Zinci Valeras — Zinci Valeratis— Zinc Valerate (U. S. P.). — Definition. — 
It should contain not less than 99 per cent, of pure zinc valerate (C 4 H 9 C00 2 )ZN -\- 2H 2 0. 

Origin. — Obtained by evaporating hot solutions of zinc sulphate and sodium valeri- 
anate, the zinc valerianate crystallizing out. 

Description and Properties. — White, pearly scales, having the odor of valerianic 
acid and a sweetish, astringent, and metallic taste. On exposure to air it slowly loses 
valerianic acid. Soluble in about ioo parts of water and in 40 parts of acohol. It 
should be kept in small, well-stoppered bottles. 

Dose. — Yz-Z grains (0.03-0.2 Gm.) [2 grains (1.25 Gm.), U. S. P.]. 

Physiological Action. — Externally and Locally. — The only 
member of this group having any special local action is camphor. 
This drug has an anesthetic effect upon the unbroken skin, but in 
a concentrated state is very irritating to mucous membranes, and 
may even produce inflammation and sloughing. Camphor is also 
a powerful parasiticide. 

Digestive System. — In medicinal doses antispasmodics stimulate 
the digestion and augment the secretions from the gastro-intestinal 
tract. They also stimulate peristalsis, and are active carminatives 
and calmatives to the digestive tract. Asafetida is the most laxa- 
tive of all. 

Large doses of any antispasmodic cause nausea, vomiting, and 
purging, camphor being the most irritant, and in toxic doses acting 
as an irritant poison. 



ANTISPASMODIC AROMA TICS. 36 1 

Nervous System. — It is probably upon the nervous system that 
these drugs exert their most potent action. They are all stimu- 
lants to the cerebrum. 

The antispasmodics, it will be seen, appear to exert a calmative 
influence upon certain nerve-centers, allaying nervous excitement 
and muscular spasm. They produce a gentle, exhilarating effect 
upon the brain, and diffuse a feeling of warmth in the system. It 
is claimed that they also possess mildly aphrodisiac properties. 
Excessive doses, on the other hand, may occasion delirium, even 
merging in maniacal excitement, this being particularly true of 
camphor, toxic doses of which drug, in the monobromated form, 
cause muscular weakness, passing into paralysis, followed by stupor 
and collapse. Valerian may occasion formication of the hands 
and feet and a condition of mental depression. 

Circulatory System. — In medicinal doses the antispasmodics in- 
crease the force of the heart and elevate arterial tension. 

Respiratory System. — The antispasmodics are all respiratory 
stimulants and stimulant expectorants. Large doses of mono- 
bromated camphor depress respiration. 

Absorption and Elimination. — These drugs are readily absorbed 
from the stomach or rectum, and are eliminated by the intestinal 
tract, kidneys, lungs, skin, and mucous membranes generally, stim- 
ulating the glands in these structures, and, in the case of asafetida 
and valerian, imparting the characteristic odor of these drugs to 
the excretions. 

Temperature. — Unaffected except by monobromated camphor, 
which in large doses acts as a depressant. 

Uterus. — The menstrual flow and sexual appetite are increased 
at first ; continued dosage, however, has a depressing effect upon 
the generative functions, camphor perhaps being the most active 
in large doses. 

Asafetida exerts the greatest influence on menstruation, while 
camphor has the most marked effect upon the general circulation. 

It is said that the sexual passion of cats is extraordinarily ex- 
cited by valerian, probably because of its odor. 

Untoward Action. — Camphor may occasion mental confusion, 
headache, vertigo, dryness of the mouth and thirst, flushing of the 
face, clammy perspiration, disturbances of digestion, and strangury. 
Musk produces similar untoward manifestations, with a sense of 
pressure in the eye-sockets and marked sexual excitement. The 
symptoms caused by valerian are very much the same, although, 
as in the untoward action of asafetida, there is more disturbance 
of the gastro-intestinal tract, such as nausea, borborygmi, diarrhea, 
and colicky pains. Barbier noted visual hallucinations in a person 
treated with valerian. 

Poisoning. — The symptoms of poisoning resemble the untoward 
action, save that the effects may be more marked, with greater 
irritation of the intestinal tract and more pronounced cerebral 
disturbance. 



362 A TEXT-BOOK OF MATERIA MEDICA. 

Treatment of Poisoning. — Coffee and the arterial sedatives an- 
tagonize the action of camphor. The patient should be treated 
symptomatica] ly ; emetics or the stomach-pump should be employed, 
and measures taken to favor elimination. Excessive nervous mani- 
festations may be controlled by opium or the bromides. 

Therapeutics. — Externally and Locally. — The only member of 
the present group used locally is camphor, its anesthetic and anti- 
pruritic properties rendering it of great value in the treatment of 
diseases of the skin. " Anderson's powder," composed of pulver- 
ized camphor, starch, and zinc oxide, is a very soothing and efficient 
dusting-powder in erythema, erythematous eczema, and urticaria. 
" Camphor-ice " and ointments of camphor, alone or combined with 
salicylic acid, are used for " chapped hands" ulcers, etc. 

Various inhalants and powders containing camphor have been 
successfully employed in the treatment of ozena, acute coryza, and 
laryngitis. Suppositories of camphor afford great relief in cases 
of chordee, while the camphor liniment is a household remedy 
for sprains, bnrises, chilblains, etc. 

Camphor chloral makes an efficient local application in neu- 
ralgia, and the campho-phenique is an excellent antiseptic, when 
mixed with oil beingr an efficient dressing - for wounds. 

Internally. — The disagreeable odor and taste of many of the 
antispasmodics — notably asafetida, valerian, and musk — greatly 
limit their use. Asafetida is an exceedingly valuable stomachic 
tonic, and singularly beneficial in the atonic dyspepsia and constipa- 
tion of nervous and anemic women. It stimulates the appetite and 
digestion, acts as a laxative, and allays much of the nervousness 
and depression from which these patients so frequently suffer. 

Asafetida is a peculiarly potent remedy in relieving paroxysms 
of hysteria and there is probably no more effective agent for the 
alleviation of flatulent colic of infants and various infantile convul- 
sions. It is here given in enemata. 

Chronic bronchitis and bronchorrhea, especially when attended 
with spasmodic dyspnea, are very favorably influenced by this rem- 
edy. Its antispasmodic action renders asafetida of considerable 
value in whooping-cough and the sympathetic cougli of mothers. 
The drug has been highly recommended in chorea occurring in 
young girls about the age of puberty, who are weak, anemic, and 
suffering from menstrual irregularities. The emulsion of asafetida, 
used as an enema, often affords prompt and complete relief in the 
tympanitis of typhoid fever. 

Camphor is a remarkably efficient anodyne, antispasmodic, and 
carminative in flatulent colic, diarrhea of infants, and the diarrhea 
of the aged produced by relaxation of the bowels. For many 
years camphor has been considered a valuable remedy in the diar- 
rhea ushering in an attack of Asiatic cholera. 

The various spasmodic and hysteric disorders for which asa- 
fetida is recommended are also greatly benefited by camphor. It 
is, moreover, a serviceable stimulant expectorant and a potent 



ANTISPASMODIC AROMA TICS. 363 

remedy, especially monobromated camphor, to allay sexual excite- 
ment and for the relief of chordee. It has likewise proved effica- 
cious in spermatorrliea. 

Dysmenorrhea and the after-pains of labor are greatly relieved 
by camphor, either alone or combined, with morphine. The drug 
has been used extensively as a cardiac stimulant and to allay the 
delirium and restlessness of typhoid, typhus, and exanthematous 
fevers. 

Camphoric acid is an efficient remedy in checking the night- 
sweats of phthisis and excessive perspiration in acute rJieumatism. 
It is recommended by Wood in eiieuresis and spermatorrhea. While 
not so efficient as camphor or monobromated camphor in spas- 
modic and hysteric disorders, it has proved of some benefit in 
these conditions. 

Camphoric acid in from 1 to 2 per cent, solution is useful in the 
treatment of acute pharyngitis and acute coryza y being employed in 
the form of a gargle or spray. 

Camphoric acid has been used internally to acidify ammoniacal 
urine in cystitis. 

Valerian has been employed for the same class of disorders as 
those treated with asafetida, but seems to be superior to the latter 
in mitigating the hysteric ma7iife stations and vasomotor disturbances 
occurring at the menopause. 

The hypochondriasis of feeble and morbidly sensitive girls and 
women is occasionally relieved by this remedy. Nervous headache 
and vertigo are often promptly relieved by valerian or the ammo- 
nium valerate. 

Valerian has been favorably recommended in both diabetes insip- 
idus and diabetes mellitus. 

Contraindications. — There are no special contraindications to 
the use of antispasmodics other than in acute inflammations of the 
gastro-intestinal tract, when camphor should not be employed. 

Administration. — Any of the preparations of the various mem- 
bers of this group may be used. Asafetida and camphor in sub- 
stance should always be given in the form cf pills or capsules. 
Camphoric acid is best administered in capsules. 



ANTIPYRETICS AND ANTIPYRETIC ANALGESICS. 



In the attempt to make an artificial quinine when it was pointed 
out that that alkaloid was a derivative of quinolene, a host of new 
bodies which have become of immense importance in modern ther- 
apeutics, has been brought into existence. A number of these 
bodies will be discussed in this chapter, and for purposes of con- 
venience they have been grouped as follows : I. Quinolene deriva- 
tives, with the general formula C 9 N 7 N. Quinine, euquinine, anal- 
gene, kairoline, thalline, cupreine, quinaphtol. II. Pyrrhol deriva- 
tives, QH 5 N, C 3 H 4 N 2 , antipyrine, tolypyrine, tolysal, anilipyrine, 
pyramidon, and other antipyrine relatives. III. Hydrazine deriva- 
tives : phenylhydrazine, pyrodine, antithermine ; and IV. Aniline 
derivatives : aniline, acetanilid, exalgine, euphorine, thermodine, 
neurodine, phenetidine, phenacetine, triphenine, lactophenine, citro- 
phen or, apolysine, malakine, phenosal, cosapine, phesin, phenocol, 
eupyrine, pyrantine, etc. 

The chemical relations of these will be pointed out later. It is 
of importance to remember that, although a large number of sub- 
stances are here printed, many of them have no real excuse for 
being. Thus, in the first group, the quinolines proper, quinine is 
practically the only one worth mentioning, and in the second group 
antipyrine is the only member of real importance. 

As for the hydrazines they are not a trustworthy series of drugs. 
They depress temperature very markedly, it is true, but they do so 
at the expense of a profound hemolytic action in the blood. 

Concerning the aniline groups, it contains many important 
drugs, principally acetanilid and phenacetine, but there are many 
others of marked therapeutic value. This group falls naturally into 

two series. In the one are derivatives of plicnylamine , N— H , 

X QH 5 
or ammonias in which one hydrogen is replaced by the phenyl 
radicle. In acetanilid another hydrogen is replaced by the acetyl 

/H 

group, or N— C 2 H 3 0, and in exalgine the third hydrogen is replaced 

/CH S 

by a methyl group N — C 2 H 3 0. The second series in this aniline 

group is termed the phenetidines, they are compounds of para- 
36 1 



QUI NO LIN GROUP. 365 

OH 
amido phenol, C 6 H 4 <^tt , in which a hydroxyl in the dioxybene- 

zol nucleus is replaced by an amido group. If an acetyl group is 
introduced in the hydrogen of the hydroxyl, C 6 H 4 <^ MT t 2 3 , 
phenetidin is the result, if an ethyl and an acetyl group are intro- 
duced, Q^4\xruV 5 u r<, phenacetine is produced, while a methyl 

instead of the ethyl gives C 6 H/^-r-rjp 3 TT ^ methacetin. Other 

substitutions are numerous in these bodies, but these are the most 
•fundamental. 

The anilines possess to a certain extent the same drawbacks as 
the hydrazines, they are destructive to the blood, but usually only 
in larger doses. Only continued experience will teach which are 
the most to be trusted. 



L QUINOLIN GROUP. 
Cinchona— Cinchonae— Cinchona. U. S. J>. 

Definition. — The dried bark of Cinchona Ledgeriana Moene, Cinchona Calisaya 
Weddell, Cinchona officinalis L., and of hybrids of these with other species of Cin- 
chona. It should yield not less than 5 per cent, of total anhydrous cinchona alka- 
loids, and at least 4 per cent, of anhydrous ether-soluble alkaloids. 

Origin. — The genus Cinchona as at present constituted consists of from thirty-one 
to thirty-six species, all of which are native to South America. The habitat of the 
three follows the eastern slope of the Andes, beginning in Bolivia and extending 
through Peru. From about 2° south latitude in Ecuador it occupies also the eastern 
slope of the Western Cordilleras, until by two narrow belts it enters the highlands of 
New Granada, whence it spreads northeast and northward into Venezuela, reaching the 
vicinity of Caracas and the Caribbean Sea. Owing to the great number of hybrids the 
delimitation of the various species of cinchona is. at the present time, almost an 
impossible task. 

The climate in which the most valuable species are found is, according to Karsten 
(1858), characterized by a rainy season lasting for nine months, heavy rains falling 
principally during the night, alternating with sunshine and fog during the day. Dur- 
ing the remaining three months of the year the nightly temperature frequently sinks 
below freezing-point, in the day-time, however, reaching 25 C. (77 F.) ? producing 
dense fogs. 

The Cinchonas are evergreen trees or shrubs, the most valuable species attaining a 
height of from 40 to 80 feet (12 to 24 M.). They are not met with in the valleys, 
but are found at altitudes varying from 330 feet (100 M.) to 11,500 feet (3500 M.). 
According to Weddell, the most valuable species grow at an altitude of 5300 to 7900 
feet (1600 to 2400 M.). All the species are found in the primeval forests, either 
singly or in collections of a few specimens. The tree is cultivated in British Sikkim, 
Ceylon, Java, and Jamaica. It is also cultivated in South America, its original home. 

Description and Properties. — In quills or in curved pieces, varying in 
length, and usually -^ or i inch (2 or 3 Mm.), or sometimes ^ inch (5 Mm.) thick ; 
the outer surface covered with a gray or brownish-gray cork, usually slightly wrinkled, 
marked with transverse and also intersecting longitudinal fissures (C Calisaya), and 
sometimes with scattered warts and slight longitudinal ridges ; inner surface light 
cinnamon-brown, very highly striate ; fracture of the outer layer short and granular, 
finely fibrous in the inner layer ; powder light- or yellowish-brown ; odor slight, some- 
what aromatic ; taste bitter and somewhat astringent. 



366 A TEXT-BOOK OF MATERIA MEDIC A. 

Cinchona Rubra— Cinchonae Rubrae— Red 
Cinchona. V. S. I*. 

Origin. — The dried bark of Cinchona succirubra Pavon, and of its hybrids con- 
taining not less than 5 per cent, of its anhydrous cinchona alkaloids. 

Description and Properties.— In quills or in curved pieces, varying in 
length, and from T ^ to \ or 1 inch (2 to 4 or 5 Mm.) thick ; the outer surface covered 
with a grayish-brown cork, more or less rough from warts and longitudinal warty 
ridges, and few, mostly short, transverse fissures ; inner surface more or less deep 
reddish-brown and distinctly striate ; fracture short-fibrous in the inner layer ; powder 
reddish-brown ; odor slight ; taste bitter and astringent. 

Among the various alkaloids found in cinchona the following are the most import- 
ant : Quinine, quinidine, cinchonine, and cinchomdine, the medicinal value of the 
bark depending almost exclusively upon the alkaloid quinine. 

Other less important ingredients are kinic and kinovic acids, kinovin, cinchotannic 
acid, cinchona-red, and a minute quantity of a butyraceous, volatile oil. The ash 
amounts to between 1 and 2 per cent., consisting chiefly of the carbonates of calcium 
and potassium. 

Dose of powdered cinchona, 15-60 grains (1.0-4.0 Gm.) [15 grains (1 Gm.) U. 
S. P.J. 

Official Preparations of Cinchona. 

Fluidextractum Cinchonae— Fluidextracti Cinchonae— Fluidextract of Cin- 
chona. — Dose, 10-60 minims (0.6-4.0 Cc.) [15 minims (1 Cc. ), U. S. P.]. 

Tinctura Cinchonae— Tincturae Cinchonae — Tincture of Cinchona (20 per 
cent.). — Dose, 1-2 fluidrams (4.0-8.0 Cc. ) [1 fluidram (4 Cc), U. S. P.]. 

Official Preparation of Cinchona Rubra. 

Tinctura Cinchonae Composita — Tincturae Cinchonae Compositae — Com- 
pound Tinctura of Cinchona (10 per cent., with bitter orange peel 8 per cent., and 
serpentaria 2 per cent.). — Dose, 1-4 fluidrams (4.0-15,0 Cc.) [1 dram (4 Cc), 
U. S. P.]. 

Official Alkaloids and Salts. 

Cinchonidinae Sulphas — Cinchonidinae Sulphatis — Cinchonidine Sulphate. 
— Description and Properties. — White, silky, acicular crystals, without odor, and hav- 
ing a very bitter taste ; slightly efflorescent on exposure to air. Soluble in 63 parts of 
water and in 72 parts of alcohol at 25 C. 

Dose, 10-30 grains (o. 6-2.0 Gm. ) [4 grains (0.25 Gm.), U. S. P.]. 

Cinchoninae Sulphas — Cinchoninae Sulphatis — Cinchonine Sulphate. — 
Description and Properties. — Hard, white, lustrous, prismatic crystals, without odor 
and of a very bitter tase ; permanent in the air ; soluble in 58 parts of water and in 10 
parts of alcohol at 25 C. 

Dose, 5-30 grains (0.3-2.0 Gm.) [4 grains (25 Gm.), U. S. P.]. 

Quinina — Quininae — Quinine. — Description and Properties. — A white, flaky, 
amorphous or crystalline powder, odorless, and having a very bitter taste ; permanent in 
the air; soluble in 1750 parts of water and in 0.6 part of alcohol at 25 C. Quinine 
should be kept in well-stoppered bottles, in a dark place. 

Dose. — 1-60 grains (0.06-4.0 Gm ) [4 grains (0.25 Gm. ), U. S. P.]. 

Quininae Bisulphas — Quininae Bisulphatis — Quinine Bisulphate. — Descrip- 
tion and Properties. — Colorless, transparent, or whitish orthorhombic crystals or small 
needles; odorless and having a very bitter taste ; efflorescent on exposure to the air. 
Soluble in 8.5 parts of water and in 18 parts of alcohol at 25 C. It should be kept in 
well -stoppered bottles, in a dark place. 

Dose. — 1-15 grains (0.06-1.0 Gm. ) [4 grains fo.25 Gm), U S. P.]. 

Quininae Hydrobromidum Quininae Hydrobromidi — Quinine Hydrobro- 
mide. — Description and Properties. — White, light, silky needles; odorless and of a 
very bitter taste. The salt is liable to lose water on exposure to wnrm or dry air. Sol- 
uble in 40 parts of water and in 0.67 part of alcohol at 25 C. It should be kept in 
well-stoppered bottles, in a o"ark place. 

Dose — 1-20 grains (0.06-1.3 Gm.) [4 grains (0.25 Gm.), U. S. P.]. 



QUINOLIN GROUP. 367 

Quininse Hydrochloridum— Quininae Hydrochloridi — Quinine Hydrochlor- 
ide. — Description and Properties. — White, silky, light and fine needle-shaped crystals, 
odorless, and having a very bitter taste. The salt is liable to lose water on exposure 
to warm air. Soluble in 18 parts of water and in 0.6 part of alcohol at 25 ° C. 
Quinine hydrochlorate should be kept in well-stoppered bottles, in a dark place. 

Dose. — 1— 15 grains (0.06-1.0 Gm.) [4 grains (0.25 Gm.), U. S. P.]. 

Quininse Sulphas — Quininae Sulphatis — Quinine Sulphate. — Description and 
Properties. — White, silky, light, and fine needle-shaped crystals, fragile and somewhat 
flexible, making a very light and easily compressible mass, lustrous from superficial 
efflorescence after 'being for some time exposed to the air ; odorless and having a per- 
sistent, very bitter taste. The salt is liable to lose water on exposure to warm air, to 
absorb moisture in damp air, and to become colored by exposure to light. Soluble in 
720 parts of water and in 86 parts of alcohol, also in 36 parts of glycerin and in about 
400 parts of chloroform, and freely soluble in dilute acids at 25 C. It should be kept 
in well-stoppered bottles, in a dark place. 

Dose, 1-60 grains (0.06-4.0 Gm.) [4 grains (0.25 Gm.), U. S. P.]. 

Quininae Salicylas — Quininae Salicylatis — Quinine Salicylate. (U. S. P.). 
— Definition. — The salicylate, 2C 20 H 24 N 2 O 2 .C 7 H 6 O 3 -\- H 2 0, of the alkaloid quinine. 

Description and Properties. — Colorless needles, permanent in air, but acquiring a 
pinkish tinge after a time. Soluble in cold water (1 : 77), somewhat more so in warm 
(1 : 35), in alcohol (I : 11), and in glycerin (I : 16) at 25 C. 

It contains 68.79 P er cent, quinine (the bisulphate contains 59. 1 per cent, quinine, 
the hydrobromide 76.6 per cent., the hydrochloride 81.8 per cent., the sulphate 74.3 
per cent.). The bisulphate is soluble in 8.5 parts of water, the hydrobromide in 40 
parts, the hydrochloride in 18 parts, the sulphate in 720 parts ; the official alkaloid 
(containing 3 molecules of water) is soluble in 1550 parts of water. 

Dose. — Average dose : 4 grains (0.250 Gm. = 250 milligrammes), U. S. P. 



Unofficial Alkaloids, Salts, and Other Quinolines. 

Chinoidinum — Chinoidini — Chinoidine. — Origin. — Obtained from the mother- 
liquor in the preparation of quinine sulphate, cinchonine, and the other alkaloids of 
cinchona. 

Description and Properties.— Cylindrical rolls or masses, of a more or less deep- 
brown or black color and a resin-like appearance. It has but a slight taste, being faintly 
bitter on mastication. Almost insoluble in water ; freely soluble in alcohol. 

Dose. — 3-30 grains (0.2-2.0 Gm. ). 

Cinchonidinae Salicylas — Cinchonidinae Salicylatis — Cinchonidine Salicyl- 
ate. — Dose, 2-10 grains (0.12-0.6 Gm.). 

Cinchonina Iodosulphas — Cinchoninae Iodosulphatis — Cinchonine Iodosul- 
phate (Antiseptol) (50 per cent, of iodine). — Description and Properties. — A light 
powder of a reddish -brown color ; insoluble in water, but soluble in alcohol. Used 
principally as a substitute for iodoform. 

Chinolin — Chinolin — Chinolin (Quinolin). — Origin. — Prepared from cincho- 
nine or quinine by distillation, or obtained synthetically. 

Description and Properties.— A colorless liquid, with an aromatic, pungent odor; 
slightly soluble in water, freely soluble in alcohol. 

Quinoline itself was at one time used as a substitute for quinine to reduce temper- 
ature, but it induces collapse and has been discarded. 

Analgine, analgen, ethoxyacetylamidoquinolin, is occasionally used. It is broken 
down into benzoic acid, quinoline, and an orange-colored antiseptic derivative, thus 
staining the urine red. It is of some service in acute articular rheumatism in doses of 
15-30 grains (1.0-2.0 Gm.). 

Dose. — 3-10 minims (0.18-0.6 Cc.).. 

Chinolin Tartras— Chinolin Tartratis — Chinolin Tartrate. — Soluble in 70 or 
80 parts of water. Dose, 5-15 grains (0.3-I.O Gm.). 

Quinetum — Quineti — Quinetum. — A mixture of the alkaloids precipitated by an 
alkali. Dose, I -60 grains (0.06-4.0 Gm.). 

Quininae Hydrochloras Carbamidata — Quininae Hydrochloratis Carbami- 
datae. — Double salt of quinine and urea. Soluble in water. Dose, 1-10 grains (0.06- 
0.6 Gm.). Usually employed hypodermically. 

Kairine (C 9 H 9 (OH)N — C 2 H 5 ) and Thalline (C 9 H 9 (OCH 3 )NH) were at one 



368 A TEXT-BOOK OF MATERIA MEDIC A. 

time extensively used as antipyretics and analgesics, but they have been found very 
depressing, and after the initial fall in temperature it has been found to rise again. 

Euquinine, an ethyl carbonate of quinine, has an action precisely similar to that of 
quinine as it breaks down into that body. It has no advantages, save those of taste and 
more ready solubility. 

The name cinchona given to Peruvian bark was accorded in 
honor of the countess of Chinchon, cured of tertian fever by the 
use of the drug, as early as the seventeenth century, the Spanish 
conquerors of the country having discerned the curative properties 
of the plant which scientific investigation has rendered invaluable 
as a therapeutic agent. 

About the middle of the seventeenth century a large quantity 
of the bark received from America reawakened a discussion, and 
finally a council of Jesuits held at Rome approved a distribution 
of the drug — called therefrom " Jesuits' bark." It quickly found 
its way to other parts of the Continent and to England ; yet still 
the opposition to its use was pronounced, and it was only when an 
English quack doctor succeeded in effecting cures among persons 
of rank by an employment of the drug that its services became 
general in malarial and typhoid fevers, as well as in various other 
diseases. 

The discovery of the active principles of cinchona, crudely es- 
tablished by Duncan in 1803, was perfected by Pelletier and Cav- 
entou in 1820 by the preparations of quinine and cinchonine. In 
1833 quinine became partially known, being completely isolated 
as an active principle in 1852, quinine and cinchonine having been 
employed since 1820-21. 

Until the researches of Marchiafava, Celli, Laveran, Golgi, and 
others had disclosed the true etiology of malaria, quinine was used 
empirically in malarial diseases, its precise action being unknown. 
Its efficacy is now ascertained to be due to its power of destroying 
the plasmodia of malaria. In addition to this action, which ren- 
ders the drug of the greatest value in malarial diseases, quinine 
possesses many other important properties, which are here con- 
sidered. 

Physiological Action. — Externally and Locally. — The drug is a 
mild germicide, preventing putrefaction and fermentation by its 
destructive influence upon fungi and infusoria, a solution of 1 : 250 
being sufficient for this purpose, while 1 : 500 is fatal to certain 
micro-organisms, and even so weak a solution as 1 : 1000 suffices to 
destroy some infusoria. 

Quinine is essentially a protoplasm-poison. It affects lower 
animals and plants, interferes, when present, with the normal 
processes of reproduction, affects the blood-cells, and, moreover, 
has a peculiar action in diminishing the activity of many of the 
unorganized ferments. 

Upon the unbroken skin it has little effect, other than to pro- 
duce occasionally a slight roughening of the surface. To raw 
surfaces, however, and to mucous membranes it is irritant. 



QUINOLIN GROUP. 369 

Internally. — Digestive System. — Its action resembles that of 
vegetable bitters, augmenting the secretions from the salivary and 
gastro-intestinal glands, stimulating peristalsis, and increasing the 
blood-supply to the stomach. Under moderate doses, therefore, 
the appetite and digestion are improved. Large dosage disturbs 
digestion, occasioning nausea, with, possibly, vomiting and diarrhea. 
The acidity of the stomach is said to be increased by quinine sul- 
phate. 

Nervous System. — Small doses stimulate the cerebrum. Large 
doses occasion cerebral congestion, with a sensation of dizziness, 
fulness in the head, and other symptoms described at length under 
" Cinchonism." 

In mammals there is a transient stimulation of the spinal cord, 
followed by a depression. In lower animals, notably the frog, 
there is a primary increase in the reflex irritability, which subse- 
quently is followed by depression, perhaps an index of the action 
of the drug on the protoplasm of the ganglionic cells. Muscular 
action is profoundly altered, quinine acting as a poison. Its action 
on sensory and motor nerves is not marked, and depressing effects 
on muscular contraction, formerly attributed to its action on the 
terminal end-plates of the motor nerves, have, of late years, been 
attributed to its action upon the muscle protoplasm itself. 

Circulatory System. — Small doses increase the force and fre- 
quency of the heart's action, excessive doses slowing and weaken- 
ing it, and, frequently in children, causing an intermittent pulse. 
Toxic doses paralyze the heart, arresting it in diastole. It is 
uncertain whether or not these effects are due to an exclusive 
action on the cardiac muscle. It is evident, though, that small 
doses elevate, and large doses depress, arterial tension. 

Quinine in a remarkable manner affects the constituents of the 
blood. The ameboid movements of the white blood-corpuscles 
are arrested, preventing their migration through the capillary walls 
in inflammation, while their number is diminished by full doses of 
the drug both in health and in inflammatory conditions. The red 
corpuscles are relatively increased in number, at least in propor- 
tion to the white corpuscles, the size of the former being dimin- 
ished in febrile conditions. 

Quinine retards or impairs all the oxidizing powers of the body, 
and materially lessens the oxygen-carrying capacity of the red 
corpuscles. This is shown in the diminished metabolism of the 
body. 

Respiratory System. — Quinine exerts but little influence upon 
the respiration, small doses slightly increasing and large doses 
depressing the respiratory movements ; death being due to respira- 
tory paralysis, at least in the lower animals. Such paralysis is 
usually accompanied by paralysis of the heart and vagus. When 
toxic doses of quinine are thrown directly into the circulation, 
paralysis of the heart may be primary. 

Absorption and Elimination. — The drug is quite rapidly absorbed 

24 



370 A TEXT-BOOK OF MA TERIA MEDICA. 

from the alimentary canal. While its presence may be detected 
in the urine within fifteen minutes after the ingestion of a full dose, 
many hours, or even days, may elapse before the drug is finally 
excreted. 

Some of the drug undergoes a change in the system, especially 
in the liver, and it may be detected in the urine as quinine and 
various isomeric modifications of it. While chiefly eliminated by 
the kidneys, it may escape from the system by other channels, 
having been found in the milk, sweat, saliva, tears, bile, and in 
dropsical effusions. Fully 90 per cent, has been recovered in the 
urine. 

The excretion of uric acid, urea, and other nitrogenous material 
is considerably diminished under the use of quinine. Products 
by oxidation other than those derived from the nitrogenous elements 
are not markedly affected, hence it is probable that quinine only 
hinders the breaking down of proteids. 

Temperature. — In health the temperature is unaffected by qui- 
nine, but in febrile conditions, particularly in malarial fever, the 
drug acts as a powerful antipyretic. Its antipyretic action is due, 
in all probability, to its action on the tissues directly. It also causes 
diaphoresis. Its action in malaria is naturally as a parasiticide. 
Many clinicians believe that it is destructive to bacteria as well as 
protozoa. 

Eye. — There have been recorded several cases of amblyopia and 
of quinine amaurosis, with transitory blindness, color-blindness, 
wide dilatation of pupil — irresponsive to light, but responding to 
accommodation effort — pallor of the optic disks, with extreme dimi- 
nution of both retinal veins and arteries and contraction of the 
visual field. 

Quinine amaurosis, however, is probably very rare, but a lim- 
ited number of cases being recorded, although Rogers believes 
that " incomplete ocular cinchonism " is of quite frequent occur- 
rence." 

Uterus. — After the inception of labor quinine seems frequently 
to stimulate the uterine contractions. It also increases a scanty 
menstrual flow. There appears to be no authoritative evidence 
that quinine is an abortifacient. 

Untoward Action. — Besides the symptoms of cinchonism from 
which some persons suffer after the ingestion of a small dose, there 
are often occasioned various eruptions of the skin, often accom- 
panied by marked pruritus, the eruption produced by the drug at 
times strongly resembling scarlatina. 

Peculiar disturbances of vision and impaired hearing not infre- 
quently attend the administration of quinine. Many patients can- 
not take it because of the incessant buzzing it causes. There have 
been recorded cases of renal and vesical irritation, varying in 
intensity, following the use of the drug. The administration of the 
salts of quinine in pill form is often followed by gastro-intestinal 



QUINOLIN GROUP. 371 

catarrh. The drug has also been known to occasion epistaxis and 
hemoptysis. 

Poisoning. — Excessive doses of quinine produce a series of 
symptoms collectively termed cinchonism. They are — a feeling of 
fulness in the head, ringing or buzzing in the ears, varying degrees 
of deafness, headache, with possibly delirium, disturbances of 
vision, vertigo, and muscular weakness. In severe poisoning there 
is nausea and vomiting, swelling of the mucous membrane, bleed- 
ing from the nose, may be from the lungs, eruptions, albumin, and 
blood in the urine, with somnolence, coma, small rapid pulse, res- 
piratory failure, and death. The lethal dose is difficult to determine. 
1 to 2 Gm. have been fatal in children ; doses of 30 Gm. have been 
taken without serious inconvenience. 

Treatment of Poisoning. — Potassium bromide and hydrobromic 
acid are the best agents to relieve the symptoms of cinchonism, 
full doses of the latter given with quinine being said to prevent 
untoward results. 

Should the dose be sufficient to depress the heart and respira- 
tion in a marked degree, cardiac and respiratory stimulants would 
be indicated. . 

Therapeutics. — Externally and Locally. — Powdered cinchona 
bark is an ingredient of many tooth-powders. Quinine also enters 
into the composition of many " hair tonics," and is highly recom- 
mended by some physicians in the treatment of alopecia. 

The drug has been employed with varying success in many 
diseases of the nose and throat, such as hay fever, whooping-cough, 
ozena, tonsillitis, etc. 

Ledetsch has highly recommended quinine bisulphate, 1 part to 
100 parts of water and glycerin, as an injection in gonorrhea. The 
drug has been used with tincture of ferric chloride as a paint to 
prevent the spread of erysipelas. A 2 per cent, solution has proved 
an efficient remedy in cystitis, effectually preventing the decomposi- 
tion of the urine. 

Internally. — Undoubtedly the principal use of quinine is in the 
treatment of malarial diseases. When we realize that quinine in 
I part to 20,000 is sometimes destructive of the plasmodium mala- 
riae, it is readily understood why the drug should be so efficient as 
an antimalarial remedy. 

Quinine is one of the most powerful antiperiodics, being of 
more or less value in many diseased conditions characterized by 
periodical exacerbations. All forms of malarial fever usually yield 
to the proper use of quinine. It seems to be somewhat efficient as 
a prophylactic. 

From a practical point of view it is fairly well established that 
at certain phases of development the malarial parasite offers less 
resistance to the action of quinine than at others. Thus, in the 
early stages of the parasite's development, particularly while in the 
blood cell, the resistance to quinine is very marked ; parasitic forms, 
which are free, swimming in the blood-serum, offer less resistance. 



372 A TEXT-BOOK OF MA TERIA MEDICA. 

The best results are obtained from quinine when . administered 
during the stage of fever or in the period immediately preceding. 
Early doses of quinine check the development of the second stage, 
and prevent, in part at least, the segmentation of the parasite. 
The practical point to be gained from the recent studies is that 
quinine given in the period preceding the fever and during fever 
is most effective in the cure of the non-pernicious types of the 
disease. As it take from two to four hours for quinine to satu- 
rate the plasma, this amount of time should be allowed and a 
dose of from 10 to 15 grains, given two to three hours before the 
chill which is thought to record the breaking free of the parasites 
from the red blood-cells. 

Many periodical affections due occasionally to malarial organ- 
isms are peculiarly amenable to this drug, among these disorders 
being various neuralgias, headache, asthma, hay fever, chorea, jaun- 
dice, diarrhea, dysentery, etc. 

It is particularly beneficial in cases of prolonged suppuration, 
such as pulmonary phthisis, fistulous discharges, septicemia, pyemia, 
puerperal fever, etc. It favorably influences the formative stages 
of acute inflammations, as in the beginning of e7ido carditis, pneu- 
monia, pleurisy, etc. 

As a tonic or restorative during the course of febrile diseases, 
as well as in convalescence, quinine is highly efficient. Its action 
upon the gastro-intestinal tract renders it valuable in many forms 
of dyspepsia, especially the atonic variety. In these cases, where 
anemia is present, the drug may be advantageously combined with 
iron and nux vomica. 

Quinine is but little used now as a pure antipyretic. Its anti- 
pyretic influence is consequently more marked in intermittent fever. 
It is of value also in typhoid, but less as an antipyretic than as a 
general tonic. 

It is of decided value in the yeasty vomiting produced by the 
sarcina ventriculi, and equally beneficial in impetigo ; while acne 
and ecthyma, when occasioned by reduced vitality and impaired 
nutrition, are greatly benefited by its internal use. 

Quinine is serviceable in stimulating the uterine contractions 
during labor and increasing the menstrual discharge in amenorrhea. 

Contraindications. — The drug is contraindicated in acute in- 
flammations of the genito-urinary and gastro-intestinal tract, in 
acute or subacute inflammations of the middle ear, and in menin- 
gitis and cerebritis. It should not be given to infants suffering from 
eczema, nor to persons having a marked idiosyncrasy against the drug. 

Administration. — Because of its intensely bitter and disagree- 
able taste quinine should not be given in solution. It may be sus- 
pended in syrup of yerba santa or in the aromatic elixir of licorice, 
which disguises the taste quite effectually, and for children is pref- 
erable, as a method of administration, to capsules or pills. In the 
case of adults the drug should be given in gelatin capsules or in 
the form of gelatin- or sugar-coated pills. 



PYRRHOL GROUP. 373 

The tannate of quinine is comparatively tasteless, and may be 
incorporated with chocolate in the form of lozenges, thus being 
readily taken by children. 

The drug may be also administered in a suppository by the 
rectum or incorporated in lard and rubbed into the skin, preferably 
in the axillae and the inner side of the thighs or over the abdomen. 
It has been employed to some extent hypodermically, the quinine 
hydrobromate and bisulphate being the salts preferred for this 
purpose. Injections should be made in the buttocks, and very 
slowly administered, since this method of administration depresses 
the heart to a considerable degree. 

Occasionally in the treatment of malaria Warburg's tincture, 
containing quinine and numerous aromatics, is efficient. 

In obstinate malarial affections aromatics and spices greatly 
enhance the effect of quinine, capsicum making one of the best 
adjuvants. The portal circulation is stimulated, rendering the 
absorption of the drug more rapid and its effects more lasting. 

The various tinctures and elixirs of cinchona are used exten- 
sively ; when employed as stomachics they should be given before 
meals. 

Quinine is best given on an empty stomach or after the active 
process of digestion is completed. 

IL PYRRHOL GROUP. 

These bodies are derivatives of pyrrazol. Thus pyrrhol, 
H 

I 
N N— H 



HC CH by the replacing; of another N, N CH ,is converted into 

HC — CH HC — CH 

pyrrazol. In antipyrine, a phenol radical is substituted for the NH 
of pyrrhol, and two methyl groups and oxygen introduced, thus — 

Phenyldimethyl pyrazolon. 



C=0 Isomeric compounds of antipyrine are known 

I I which are inert. 

L CH 

Antipyrina— Antipyrinae— Antipyrine. TJ. S. P. 

Definition. — Phenyldimethylpyrazolon obtained by the condensation of phenyl- 
hydrazine with aceto-acetic ether and methylation of the product. 

Description and Properties. — A white, crystalline powder, odorless, of a 
slightly bitter taste, freely soluble in water, alcohol, and chloroform. 

Dose. — 3-20 grains (0.I9-I3.0 Gm.). 

Antagonists and Incompatibles. — Antipyrine is incompatible 
with spirit of nitrous ether and nitrous compounds, the chlorides 
of mercury, the iodides of arsenic and mercury, the ferric salts in 



374 A TEXT-BOOK OF MATERIA MEDICA. 

solution, tincture of iodine, most of the vegetable astringents, car- 
bolic acid, chloral, beta-naphtol, sodium bicarbonate, sodium salicyl- 
ate, and the salts of quinine and caffeine. 

Antipyrine is a weak antiseptic. 

Physiological Action. — On the skin it has no action. It irri- 
tates mucous membranes and blanches them, and is an analgesic. 
Hypodermically administered it often forms abscess. 

Digestive System. — Antipyrine being readily soluble, is absorbed 
rapidly. It is slightly irritant to the stomach, blanches its surface 
by local contraction of the blood-vessels, and may act as a hemo- 
static. It hinders the activity of the diastatic ferment and may even 
cause nausea and vomiting. It has little or no action on the intes- 
tines, because of its rapid absorption. 

Nervous System. — Antipyrine has a pronounced action on the 
nervous system. It causes irritability of the motor cortex, in lower 
animals bringing about convulsive seizures. In man it may bring 
about excitement and a peculiar type of intoxication, accompanied 
with marked general analgesia. It occasionally interferes with 
normal intellectual labor. It excites the medulla and then brings 
about a diminution in its functions and may abolish the spinal 
reflexes. The cutaneous nerves of sensation are rendered markedly 
analgesic. 

Circulation. — In small doses after a preliminary rise in blood- 
pressure the vessels dilate and the peripheral blood-pressure falls. 
The central pressure is not much affected. The pulse rate, at first 
accelerated, becomes slower. The effects of toxic doses is to cause 
distinct loss of blood and a weak feeble heart. 

Antipyrine has no appreciable action on the blood itself. In 
this respect it varies greatly from the aniline derivatives, and from 
this point of view is a much safer analgesic. 

Temperature. — Antipyrine reduces temperature very rapidly in 
fever. Its action in health is slight. The heat reduction is largely 
due to increased surface evaporation, from dilated blood-vessels and 
increase of perspiration. The exact mechanism is not as yet fully 
understood. A certain proportion of the heat reduction is due to 
a retardation of metabolism. This is probably not as marked for 
antipyrine as it is for the quinolines. 

Antipyrine is very apt to cause a rash. This rash may resem- 
ble the eruption of many eruptive fevers, and hence the use of anti- 
pyrine should be withheld in these conditions until a definite diag- 
nosis is made. 

Poisoning. — In large doses, 30 grains and over, in some indi- 
dividuals, even in smaller doses, it may bring about a marked feel- 
ing of chilliness, dyspnea, vertigo with rapid and feeble heart 
action, unconsciousness, and collapse. Occasionally, convulsive 
seizures are noted. Cyanosis is usually present, irregular breath- 
ing, even Cheyne-Stokes rhymth ; the pulse is small and death 
may result from cardiac collapse. The temperature usually falls, 
but often while the patient is in coma there may be a distinct 



HYDRAZINE DERIVATIVES. 375 

rise in the temperature. 45 grains (3 Gm.) has caused death in 
a patient with a weak heart. j\ grains (5 Gm.) has caused serious 
symptoms. The continuous use of small doses of antipyrine has 
been known to bring about a tendency to hemorrhages from the 
mucous membranes. 

In large doses it causes slow and irregular breathing. 

Absorption and Elimination. — Kidneys. — Antipyrine lessens the 
amount of urine, urea, and uric acid excreted, but increases the 
amount of sulphuric acid in the urine. 

Therapeutics. — As an analgesic antipyrine probably ranks next 
to opium, and is useful in all conditions which call for the treat- 
ment of pain. The anesthesia produced by antipyrine often lasts 
for several hours or even days. In acute coryza and inflammation 
of the pharynx great relief is obtained by spraying the parts with 
a 2 or 4 per cent, solution, after applying a solution of cocaine to 
prevent the primary smarting and irritation which the antipyrine 
produces. 

A 20 per cent, solution has been used in otitis, and a 4 per cent, 
solution has been found very efficient in cystitis. 

Antipyrine has been used with some success in diabetes mellitus 
and malarial diseases, particularly in intermittent fever. It does not, 
however, possess the antiperiodic and specific action of quinine in 
malarial poisoning. It is an excellent antispasmodic in whooping- 
cough, laryngitis, and asthma. 

Administration. — The drug is best given in water or some 
aromatic water or syrup. It should not be given hypodermically. 
In hemorrhage the powdered drug may be applied locally, or a 
40 per cent, solution, which causes less irritation. From \-2 grains 
(0.03-0.12 Gm.), once or twice a day, is sufficient for children. 
Ordinarily, a dose of 5 grains (0.3 Gm.) is sufficient for an adult. 

Allied Compounds. 

Antipyrine unites with resorcin to form resopyrin; with salicylic acid to form sali- 
pyrin ; with chloral hydrate to form hypnal and other compounds. Pyramidon is a 
dimethylamido substitution product of antipyrine. Ferripyrin is a combination of ferric 
chloride and antipyrine. Many other compounds are known. Antipyrine is a constitu- 
ent of many "migraine powders." 

Dose. — Average dose : 4 grains, (0.250 Gm. = 250 milligrammes), U. S. P. 

Caution. — On account of the wide range of incompatibilities 
already indicated, the greatest caution should be observed in com- 
bining antipyrine with other substances. 

HI. HYDRAZINE DERIVATIVES- 

Practically none of the hydrazines are in use at present. Phenyl- 
hydrazine, pyrodine, a related compound, antithermine , orthin, and 
agathine, a salicylic acid substitution product were at one time in use. 
They depress temperature very rapidly, but the depression is but 
temporary only, and as they cause severe poisoning they have been 



376 A TEXT-BOOK OF MATERIA MEDICA. 

abandoned. The symptoms of poisoning from the hydrazines 
have been : profuse sweating, with reduction of temperature ; cya- 
nosis from the rapid formation of methemoglobin, icterus, a rapid 
fluttering pulse with great depression, dyspnea and death from 
respiratory failure. 

IV. THE ANILINES. 

A large number of very valuable analgesic antipyretics have 
found a definite place in practical medicine. Their number is liable 
to increase very materially. In general the pharmacodynamic 
action of all of the aniline derivatives is similar. They are all 
poisonous, but their toxic actions will vary, largely, depending on 
dosage, on the nature of the substituted radicle, on the position in 
the molecule of the substituted radicle. In all of the anilines the 
skin, the digestive tract, the nervous system, and the blood are 
affected. Skin eruptions are various, herpes, urticaria, prurigo, 
pemphigus, ecthyma, or eczema may be encountered. 

The digestive symptoms are numerous and variable. Anorexia 
is common, constipation is also characteristic ; nausea and vomiting 
not infrequent. 

The nervous system may present symptoms of paresis or par- 
alysis of the voluntary muscles particularly, and analgesic action is 
constant for all of the anilines. 

The blood-changes induced by this group are of extreme im- 
portance. They may consist of oxygen fixation with the forma- 
tion of methemoglobin or even of hemolysis, with methemoglobin 
production. These blood-changes are largely due to the action of 
para-amido-phenol, into which, or compounds of which, practically 
all of the derivatives of this series are broken down. 

The number of these compounds is so numerous that only those 
that have been clinically valuable can be mentioned. The chief of 
the earlier members of this group is acetanilid. 

Acetanilidum 1 — Acetanilidi— Acetanilid. 77. S. P. 

Origin. — The monacetyl derivation of aniline. 

Description and Properties. — White, shining, micaceous, crystalline lam- 
inae, or a crystalline powder, odorless, faintly burning taste, permanent in air, neutral to 
litmus-paper. It is soluble, at 25 C. (77 F ), in 179 parts of water. 2.5 parts of alcohol, 
18 parts of boiling water, and in 0.4 part of boiling alcohol; also 111 18 parts of ether, 
and easily soluble in chloroform. 

Dose. — 2-10 grains (0.1-0.65 Gm. ) [4 grains (0.25 Gm.),U. S. P.]. 

Official Preparation. 

Pulvis Acetanilidi Compositus — Pulvis Acetanilidi Compositi — Com- 
pound Acetanilide Powder (U. S. P.). — A mixture of acetanilid, caffeine, and sodium 
bicarbonate ; it is a modification of the National Formulary article of the same name 
and has been known as acetanilid compound (Aulde). The sodium bicarbonate 
increases the solubility of the acetanilid. ' 

1 Antifebrin is a copyrighted name for acetanilid or phenylacetamide, as it is some- 
time- called, Many proprietary remedies sold at comparatively high prices are mixt- 
ures of acetanilid and other compounds. 



THE ANILINES. 377 

Dose. — Average dose, 7 £ grains (0.500 Gm. = 500 milligrammes), U. S. P. 

Acetanilid is the cheapest of the common analgesics and it is extensively used in 
the "headache powders 1 " sold under such a variety of names. These powders fre- 
quently contain also caffeine and an alkaline salt, usually sodium bicarbonate or 
ammonium carbonate. 

Physiological Action. — Externally a?zd Locally. — Antiseptic, 
slightly sedative. 

Internally. — Digestive System. — Non-irritating, sedative ; medic- 
inal doses sometimes allay nausea. 

Nervous System. — In medicinal doses acetanilid is a sedative to \ 
the sensory nerves and spinal cord. Small doses are mildly stim- 
ulant to the brain, and under certain conditions the drug- is a 
hypnotic. Toxic doses result in general anesthesia and abolition 
of reflexes, with paralysis of motor and sensory nerves. 

Circulatory System. — In medicinal doses the arterial tension is 
slightly raised, while the heart is slowed. Toxic doses directly 
depress the heart and vasomotor mechanism, causing an immediate 
fall of arterial pressure and great cardiac depression. 

In large doses or when taken for some time in comparatively 
small doses acetanilid develops the characteristic blood-changes 
spoken of. Methemoglobin is formed, and in very large doses, 
hemolysis may occur. 

Respiratory System. — Medicinal doses produce no special effect. 
When toxic doses are given there is a rapid and labored respiration. 
Death is produced by respiratory failure, due to direct action of the 
drug upon the respiratory center, and indirectly by greatly de- 
creasing the oxygen-carrying power of the blood and by paraly- 
zing the peripheral motor nerves. 

Absorption and Elimination. — Acetanilid is an active diuretic, in- 
creasing the excretion of urea, and to some extent the excretion of 
uric acid. After toxic doses have been taken the urine becomes 
dark or brownish in color, from the presence of disorganized cor- 
puscular elements of the blood. Acetanilid is chiefly eliminated 
by the kidneys as para-amido-phenol combined with acetic, sul- 
phuric, or glycuronic acids. 

Temperature. — Acetanilid has little or no effect on the normal 
body temperature ; but if the latter is above normal, the drug has 
a marked antipyretic action, often reducing the temperature to 
below normal. This effect of acetanilid, and of the aniline group 
in general, is due largely to the action of the drug on the heat- 
governing mechanism. When the body is in a state of hyperpy- 
rexia the heat-governing mechanism is in an irritable condition, owing 
to certain poisons circulating in the blood, and will not respond to 
the normal limit (98. 6° F.) of body temperature. Acetanilid causes 
this mechanism to respond to a lower temperature, and, through 
its action on the vasomotor center, stimulates the vasodilators, 
thereby augmenting the peripheral circulation with consequent in- 

1 For analysis of a number of these powders, see Lour. Am. Med. Assoc, vol. xliv., 
p. 1791, 1905- 



3?8 A TEXT-BOOK OF MATERIA MEDICA. 

crease of heat-dissipation. The exact mechanism is far from being 
understood. 

Eye. — Medicinal doses have no apparent influence on the eye. 
Toxic doses have produced contracted and motionless pupils. 

Untoward Action. — Under prolonged use of acetanilid conges- 
tion of the liver, kidneys, and spleen occurs. Paroxysms of sneez- 
ing have apparently been induced by a medicinal dose, and, under 
the same, redness of the skin, chilliness, and cyanosis have some- 
times ensued. 

Poisoning. — The skin is cyanosed, the face is livid and anxious, 
and the body is covered with cold sweat. There may be vomiting ; 
the pulse is soft, slow, later rapid, and weak, accompanied by pro- 
found prostration. The respirations are first rapid and labored, 
and later slow and very shallow, death resulting usually from res- 
piratory paralysis. There may be hallucinations, muscle twitch- 
ings, convulsions from asphyxiation, icterus, and skin eruptions. 
After death the heart, liver, and kidneys are found in a state of 
acute fatty degeneration. j\ grains (0.5 Gm.) given nine times in 
five days has caused death ; 30 grains (2 Gm.) within twenty-four 
hours has also been fatal, and 1 grain (0.5 Gm.) has caused the 
death of a one-year-old child. 

Treatment of Poisoning. — Diffusible stimulants, like alcohol, in 
small doses, ammonia, and sulphuric ether. Coffee, atropine, and 
strychnine hypodermically as circulatory and respiratory stimu- 
lants. External heat and, if necessary, oxygen inhalations to over- 
come cyanosis. Artificial respiration is imperative. 

Therapeutics. — Externally and Locally. — Acetanilid has been 
locally applied for the treatment of chancre and chancroid, but there 
are other antiseptics which are generally considered to be more 
satisfactory. It is quite an active hemostatic, and may be used in 
epistaxis and hemoptysis. 

Internally. — The use of acetanilid in fevers has been practically 
abandoned by the great majority of clinicians. If an antipyretic 
of this character is indicated at all, it is in sthenic fevers, and then 
to be used only with great care. Its tendency to cause cardiac 
depression, profuse sweating, and collapse renders its use harmful, 
if not unsafe, in low conditions like typhoid fever and advanced 
phthisis. It may often be administered with good effect in the first 
stage of pneumonia. The headache, fever, and other unpleasant 
symptoms in the exanthemata are greatly modified by its use, 
although when this drug is given to children they must be very 
carefully watched to avoid untoward effects. 

In acute tonsillitis, in influenza, in acute bronchitis, acetanilid 
is very serviceable. 

There is considerable difference of opinion in regard to the 
utility of acetanilid in rJicumatism. Some authorities believe that 
it exercises a most favorable influence in the acute articular variety, 
being less apt to disturb the brain than salicylic acid or its salts. 
The drug certainly mitigates, and often entirely relieves, the pain 



THE ANILINES. 379 

and swelling, while it reduces the fever. Like salicylic acid, it has 
no power to prevent heart-complications, but, on the contrary, it 
should be used with great care, if at all, when such complications 
exist. It has no tendency to prevent relapses. 

The dose of acetanilid in acute rheumatism should not exceed 
6 grains (0.5 Gm.) three times a day. 

Acetanilid is a very efficient analgesic, and the introduction of 
this drug, antipyrine, and other remedies of this character has 
enabled the physician to relieve the pains of certain spinal diseases 
more efficiently than was possible before. 

The crises of locomotor ataxia are often promptly relieved by 
acetanilid. Neuralgias of every kind indicate its use. The pains 
of neuritis, lumbago, gastralgia, dysmeiiorrhea, sciatica, tabes dor- 
salis, and nearly every kind of headache usually yield to its anal- 
gesic influence. 

In many cases of chorea and epilepsy (especially the diurnal 
variety), and in those cases characterized by full habit and high 
arterial tension, the drug has often been employed to advantage. 

Pains which are paroxysmal in character yield best to acetanilid. 
It quiets the excitement in mania a potu, and frequently lessens the 
paroxysms of whooping-cough. 

In doses of 3 to 5 grains (0.2-O.032 Gm.), thrice daily, acetanilid 
has proved efficient as a relief for seasickness. It has also been 
found serviceable in traumatic tetanus, purely to quiet the nervous 
symptoms. 

Contraindications. — In low fevers, at any rate, not in repeated 
doses ; in fatty or dilated heart, blood disorders, advanced tuber- 
cular disease, and exhaustion from hemorrhages. 

Administration. — It may be prescribed in powders, pills, com- 
pressed tablets, capsules, or alcoholic solution. A speedier effect 
is produced if it is taken dissolved in a small quantity of alcohol or 
wine diluted with water. 

The average dose as an antipyretic usually should not exceed 
5 grains (0.3 Gm.) ; as an anodyne, 2 to 5 grains (0.1-0.3 Gm.). It 
may be repeated at intervals of about four hours or less, according 
to its effects. 

Exalgine (Methylacetanilide). 

Origin. — As the chemical name indicates, this substance is a derivative of ace- 
tanilid. 

Description and Properties.— Exalgine occurs in colorless needles or prisms, 
inodorous and tasteless. It is neutral to test-paper, and is freely soluble in alcohol, 
chloroform, carbon disulphide, and boiling water. It requires about 60 parts of cold 
water or 10 parts of ether for solution. 

Dose. — 2-4 grains (0.1-0.2 Gm.). 

Antagonists and Incompatibles. — Exalgine is incompatible 
with the iodides, salicylic acid, and solution of potassa. 

Synergists. — All members of this group, as well as opium, 
cocaine, belladonna, and hyoscyamus. 

Physiological Action. — Exalgine is almost identical in its action 



380 A TEXT-BOOK OF MATERIA MEDICA. 

with acetanilid, with the exception that it possesses less antipyretic 
power. In medicinal doses the drug increases arterial tension, and 
in full doses profoundly affects the cerebrospinal axis. It is more 
uncertain and not as safe as acetanilid. 

Acetphenetidinum— Acetphenetidini— 
Acetphenetidin. U. S. B. 

(Phenacetin.) 

Description. — The derivation of acetphenetidin is shown by the following 

formulas : 

C«H 4 < H -^ C 6 H 4<NH. 2 ({)— >C ^<NH 2 5 — ^ C 6 H *<NH(COCH 3 ) 

Phenol. Para-amidophenol. Para-phenetidin (Para- Acet-paraphenetidin 

amido-phenetol). (phenacetin). 

It may be regarded as acetanilide, Ce^^NHYCOCH \ in which one hydrogen 
atom is replaced by the ethoxy group (OC 2 H 5 ). It occurs as white, glistening, crys- 
talline scales, or fine crystalline powder, odorless and tasteless. It is slightly soluble 
in water (1 : 925 ), much more so in boiling water ( 1 : 70), and still more so in alcohol 
(1:12). It is frequently adulterated with acetanilide, which may be recognized by the 
pharmacopceial test. 

Incompatibility. — Incompatible with phenol, chloral hydrate, iodine, salicylic 
acid, and oxidizing agents. 

Dose. — Average dose, Tj4, grains (0.500 Gm. =500 milligrammes), U. S. P. 

Physiological Action. — Phenacetin differs from acetanilid only 
in the greater slowness of its action. 

It is a distinct diuretic, but not so active as acetanilid. When 
large doses have been taken the urine is dark-yellow in color and 
gives the reaction for sugar. 

As an antipyretic phenacetin is slower in its action than acetan- 
ilid, this slowness of action thus rendering it somewhat safer; nor 
is it so powerful as an analgesic and hypnotic. 

Therapeutics. — Phenacetin is given in the same class of diseases 
as acetanilid. 

Contraindications. — The same as for acetanilid. 

Administration. — The drug may be dispensed in powders, pills, 
capsules, tablets, or suspended in mucilaginous drinks. 

Phenocoll. 

Origin. — Amido-acetparaphenetidine, a glycocoll derivative of phenetidine. The 
phenocoll hydrochloride is the salt used in medicine. 

Description and Properties. — A white, crystalline powder, soluble in 16 
parts of water, and freely soluble in hot alcohol, forming a neutral solution. 

Dose. — 3-15 grains (0.2-1.0 Gm.). 

Incompatibles. — All the alkalies. 

Physiological Action. — Phenocoll differs from phenacetine in 
no essential particulars. 



THE ANILINES. 381 

Other phenetidine bodies are : 

Lactophenin, in which a lactyl derivative is added to pheneti- 
dine. It is more soluble than phenacetine, and the lactyl group is 
supposed to add some hypnotic action. 

Saliphenin is too weak to be of any service. 

Citrophen and Apolysin are combinations of citric acid and phe- 
netidin. The citric acid radical was added for its stimulating effect 
on the heart, and hence these two are reputed to overcome the 
phenetidin-depressing effect on this viscus. The action, however, 
clinically, cannot be detected from that of phenacetin, and, more- 
over, there are certain objections, in the way of the splitting of 
these compounds in the stomach, which render them less suitable 
than phenacetine. 

Salicylphenetidin was devised to combine the antirheumatic and 
antipyretic factors, but it appears that this compound is too stable 
and does not break up into its constituents, and is found in the 
urine in its original form. 

Malakin is somewhat similar to the former drug. It breaks off 
a phenetidin, however, but is very slow of action and requires large 
doses to reduce the temperature. 

Salocoll is similar to phenocoll plus salicylic acid. 

Phesin and Cosaprin are new sulphur compounds of phenacetin 
and acetanilid, respectively, in which the sulphur radical is intro- 
duced to reduce the blood-toxic action. They offer no particular 
advantages. 



ALTERATIVES. 



This old term of the Materia Medica is here retained for pur- 
poses of convenience. By it is meant that certain substances 
exert a distinct influence on the metabolism of many of the bodily 
organs, and that they thus alter the nutritional state of the body, 
in part or as a whole, and that they have their chief use in thera- 
peutics to so influence certain metabolic activities. Thus, it is known 
that arsenic affects the nutrition of the skin ; it induces in large 
amounts characteristic nutritional disturbances. Iron has a pro- 
found part to play in the blood-composition and on the oxidizing 
functions of the body. Mercury has a peculiar action on certain 
pathological states, and exerts a specific activity in overcoming the 
effects of the syphilitic infection ; How ! it is as yet undetermined. 
Salts of iodine show similar properties. Other illustrations are 
numerous. 

At the present time the so-called alteratives are a motley collec- 
tion, and it is perfectly justifiable to treat as individuals most of 
the substances here treated in a group. Only by shutting the 
eyes to many of their divergent effects can one legitimately make 
a classification ; yet, from the practical standpoint of the therapeu- 
tist, as well as from that of the teacher, it is deemed justifiable to 
so arrange them. Furthermore, they belong for the most part to 
the general group of the metals and metalloids, and show certain 
general similarities of action. 

Phosphorus— Phosphori— Phosphorus. TJ. S. JP. 

Definition. — It should contain not less than 99.5 per cent, of pure phosphorus. 

Origin. — It exists, chiefly as phosphates, in many minerals and in all plants and 
animals. It is prepared by treating calcined bones with sulphuric acid, evaporation, 
and distillation. 

Description and Properties. — A translucent, nearly colorless solid, of a 
waxy luster, having at ordinary temperatures about the consistence of beeswax. When 
kept for some time the surface becomes red and occasionally black. Phosphorus has a 
distinctive and disagreeable odor and taste (tasting being allowable only in the form of 
extreme dilution). When exposed to the air it emits white fumes, visible in the dark, 
which have an odor somewhat resembling that of garlic. Upon prolonged exposure to 
air it takes fire spontaneously. 

Phosphorus is insoluble, or nearly so, in water, to which, however, it imparts its 
characteristic disagreeble odor and taste. It is soluble in 350 parts of absolute alco- 
hol, in 80 parts of absolute ether, and in about 50 parts of any fatty oil. It is very 
soluble in chloroform or in carbon disulphide, the latter yielding a solution to be handled 
with the greatest care to prevent accident from combustion. The drug should be care- 
fully kept under water, in strong, well-closed vessels, in a secure and moderately cool 
place, protected from light. 

Dose. — TOff-^G g ram (0.0006-0.002 Gm.) [jl-% grain (0.0005 Gm. ), U. S. P.]. 
382 



AL TERA TI VES. 383 

Official Preparation. 

Pilulae Phosphori — Pilulas (ace.) Phosphori — Pills of Phosphorus. — Dose, 
one to two pills. Each pill contains T ^ grain (0.0006 Gin. ) of phosphorus. 

Antagonists and Incompatibles. — The principal chemical anti- 
dotes are hydrated magnesia, lime water, powdered charcoal, cop- 
per sulphate, and old acid turpentine. 

Synergists. — Oily or fatty substances generally aid the action 
of phosphorus by increasing its absorbability. 

Physiological Action. — Externally and Locally. — Applied to 
the skin, phosphorus causes local inflammation, ulceration, and 
possibly gangrene. The fumes, so common in factories in which 
phosphorus is used — i. e. y in making matches — may produce the 
most serious results — even maxillary necrosis where dental caries 
is present, as well as great irritation of the conjunctivae and the 
respiratory mucous membrane. The graver systemic symptoms 
are confined to the conditions induced by toxic doses of the drug. 

Internally. — Digestive System. — Taken into the stomach, no 
special effect is apparent as a result of small doses, save that the 
drug acts as a functional stimulant. Ferment action is not impaired 
by non-poisonous doses. Large non-toxic doses cause irritation, 
with anorexia, increased peristalsis, diarrhea. Fatty degeneration 
of the cells of the mucosa is readily induced. 

Nervous System. — Small or moderate doses act as general stim- 
ulants to the entire nervous system. Toxic effects include coma, 
and occasionally vertigo, with delirium, convulsions, insensibility, 
and collapse. 

Circulatory System. — The primary action is stimulating, the 
pulse-rate rising and acquiring more force, though not firmness. 
The facial capillaries are dilated, often congested ; the cutaneous 
circulation becomes more rapid ; and diaphoresis is produced. Under 
toxic doses the action of the heart is strongly depressed. 

Respiratory System. — The deleterious action of the fumes of 
phosphorus is exemplified in their irritating effect upon the bron- 
cho-pulmonary mucous membrane. Toxic symptoms are often 
accompanied by serious disturbances, respiratory failure being 
among the immediate causes of death. Small doses of phosphorus 
have no marked action on the function of respiration. 

Liver, Bones, and Metabolism. — Phosphorus acts very markedly 
upon the cells of the liver. Its chief action, apart from certain 
corrosion effects, may be said to be exerted on this organ. In small 
doses it probably induces a specific irritation whereby the normal 
functions of the liver are enhanced. More bile is produced, and 
it is more highly pigmented. Possibly the so-called tonic proper- 
ties of phosphorus are dependent on this, as yet little understood, 
increase in biliary activity. But phosphorus, even in small doses, 
soon brings about retrograde changes in- the liver cells. With these 
is associated a certain loss in the oxidative properties of this 
organ. The production of ammonia, leucin, and tyrosin, which are 



384 A TEXT-BOOK OF MATERIA MEDIC A. 

found in the excreta, and the presence of lactic acid in the blood 
and tissues, seem to show that this loss is one of the early changes 
induced in the liver cells by this drug. Further irritation leads to 
engorgement of the organ, mechanical difficulties in the elimina- 
tion of the bile formed, and general jaundice. Further fatty de- 
generation takes place, either as a result of the lessened oxidative 
capacity of the liver, or as a concomitant, and more serious met- 
abolic disturbances occur, which cannot be entered on here. The 
general fatty degenerations caused are discussed in the paragraph 
on Poisoning. 

The bones also are the site of a specific effect of phosphorus 
action. This consists largely in a specific irritation of the bone- 
forming cells, by which they are increased in number and ossifying 
cartilage lays down more bone than is normally formed. Over- 
irritation leads very readily to destruction of bone-formation and 
to necrosis. 

Kidneys. — Phosphorus irritates the kidney epithelium. There 
is albuminuria ; fatty casts and blood may even appear in acute 
poisoning. The urine is increased in amount under small doses. 
Diminution of urine and anuria, as well as other changes in the 
substances found in the urine, are symptoms of intoxication. 

Absorption and Elimination. — The modus operandi of absorp- 
tion is a matter of some dispute. Absorption is very slow, and if 
much phosphorus be ingested it may pass through with the feces. 
Probably a portion of the drug undergoes oxidation in the stomach, 
and the phosphoric acid formed, combining with the alkalies, enters 
the blood as phosphates. A part of the phosphorus is dissolved 
in the fats and oils present in the stomach, probably entering the 
circulation as elementary phosphorus. 

Temperature. — Owing to capillary expansion, the superficial 
temperature is at first slightly raised, being subsequently dimin- 
ished. Evaporation and radiation, arising from profuse diaphoresis, 
contribute to thermal reduction. 

Eye. — In chronic poisoning from phosphorus, hemorrhages and 
patches of degeneration in the retina are sometimes visible ; the 
ophthalmoscopic picture resembling the retinitis of albuminuria. 
Under medicinal doses no special effects upon the eye are reported, 
although, as has been stated, the vapor of phosphorus is highly 
irritant to the conjunctivae. 

Uterus. — The action of phosphorus tends to increase the men- 
strual flow. 

Lfjitozvard Action. — Small doses produce in some individuals 
severe gastric disturbance, and in rare cases diarrhea, tenesmus, 
and jaundice. The fatty degeneration of the retinal capillaries, 
just mentioned — such as results from chronic intoxication affect- 
ing workers in match-factories — is an untoward manifestation to be 
guarded against by every available means. 

Poisoning. — The effects of a fatal dose of phosphorus are not 
immediate. Indeed, as shown by Kionka, large doses of phos- 



AL TERA TI VES. 385 

phorus may be ingested without any poisonous symptoms, but if 
the drug is finely divided poisonous symptoms occur. In some 
patients a rapid onset, thirty minutes to four hours, has been ob- 
served. Nausea, vomiting, heart weakness and coma are rapidly 
followed by death. This type of poisoning is occasionally observed 
from the use of certain abortion pills sold usually by the Chinese. 
In the majority of instances the protracted gastro-enteric form of 
poisoning occurs. 

In these forms the acute symptoms subside, and the hope is 
raised that the patient will recover, but after a lapse of several 
hours or even two to three days, the symptoms of the acute stage 
may recur. There is great weakness, accompanied in a large ma- 
jority of cases by vomiting. Abdominal pains follow, the symptoms 
becoming more acute, mucus and bile being present in the dejecta, 
which for a while retain the odor and luminosity of phosphorus. 
With the cessation of vomiting pain is abated, although it may 
extend over the entire abdominal region and even be attended with 
paroxysms. 

The foregoing symptoms are accompanied by pronounced 
anorexia, thirst and fever, a thickly coated or whitish tongue, 
burning in the throat, and often signs of collapse. The temper- 
ature at first may be high ; it subsequently sinks below the normal. 
After thirty-six hours or more jaundice sets in. The liver is usu- 
ally swollen, and tender to pressure. The urine is diminished, 
becoming charged with albumin and urates, and even bloody, con- 
taining among other ingredients biliary acids and coloring-matter. 
In fatal cases urea is almost wholly wanting. The stools may be 
normal, but the general condition is usually marked by diarrhea or 
constipation and flatulence. Hemorrhage often occurs, wounds 
bleeding profusely, and as the severity of the symptoms increases 
delirium ensues, or coma terminating in convulsions. 

Serious nervous manifestations are frequently preceded by rest- 
lessness, insomnia, headache, and vertigo. In some delirious con- 
ditions wild, erotic states of the mind are the precursors of convul- 
sive or comatose symptoms. Somnolence is not uncommon, with 
partial spasms and contraction or paresis of the voluntary muscles. 

In cases of acute poisoning the duration of the malady varies 
greatly, death occurring at times within a few days, or, again, being 
deferred for a few weeks. As a rule, recovery is retarded, the 
elimination of the drug requiring time. \\ grains (0.1 Gm.) are 
given as the lethal dose ; f grain (0.05 Gm.) has proved fatal, and \ 
grain has given severe symptoms. 

Postmortem examination shows that the liver, heart, kidneys, 
muscles, capillaries, and arterioles are implicated in the general 
effects of the poisoning, and are undergoing fatty degeneration. 

The symptoms of chronic poisoning are in some respects espe- 
cially marked, inhalation of phosphorus-fumes frequently resulting 
in pronounced conditions of necrosis, particularly of the lower max- 
illary, although it has been maintained that this feature of the poi- 

25 



386 A TEXT-BOOK OF MA TERIA MEDIC A. 

soning is contingent upon denuded surfaces of bone, disintegration 
or softening of tissues, caries of the teeth, or communicating wounds. 
Very rarely the palate and frontal bones are similarly attacked. 

Treatment of Poisoning. — Emetics and purgatives are from the 
first necessary. Copper sulphate is the most efficient emetic as well 
as the best chemical antidote. Hydrated magnesia, charcoal, and 
lime water have been suggested, yet their action is tardy, and a 
more efficient antidote is desirable. Several chemical and physio- 
logical agents have been employed to counteract the effects of the 
drug, among them old acid (oxygenated) oil of turpentine and 
potassium permanganate in a \ per cent, solution, opium being 
used as a stimulant to the heart and the circulatory system. 
Cathartics, such as castor oil, or other oily menstrua, are to be 
avoided. Some toxicologists teach the contrary doctrine. 

As prophylactic measures for the protection of workmen against 
phosphor-necrosis, masks covering mouth and nose have been 
found serviceable, as well as inhalation of the vapor of turpentine, 
obtained by suspending a small bottle of the fluid at the neck. 
The teeth should be kept constantly in good condition, since caries 
favors the tendency to necrosis. 

Therapeutics. — Phosphorus is not used externally, but inter- 
nally it is a tonic, especially of the nervous and osseous systems, 
stimulating protoplasmic activity. According to Gubler, however, 
" phosphorus is a rapid stimulant, but it acts by causing waste, and 
not by increasing power ; it impoverishes, and does not enrich ; 
it momentarily galvanizes, as it were, the torpid functions, but is 
incapable of renewing a dilapidated constitution or even a nervous 
system exhausted by chronic disease." 

Clinical experience has certainly demonstrated its utility as a 
nutrient tonic to the nervous and osseous tissues. In neurasthenia 
and chronic nervous exhaustion it is highly efficacious. Some cases 
of 7ieuralgia y particularly of the fifth nerve and accompanied by 
great debility, may be relieved by full doses administered every 
four hours. 

It is claimed by some observers that attacks of angina pectoris 
have been completely relieved by phosphorus. 

It has proved of great value in caries, delayed resolution of bone, 
osteomalacia, and rachitis, and the drug is credited with the cure of 
pernicious anemia, though it is singular, if the drug possesses any 
real value in this disease, that the fact has been recognized by so 
few observers. Such able men as Fox and Broadbent praise its 
efficacy in lympliadcnoma. 

Administration. — Since many persons have a peculiar suscepti- 
bility to phosphorus, its administration should begin with small 
doses, and, should it be thought necessary to prolong the adminis- 
tration for an indefinite period, the tendency of the drug to produce 
general steatosis should not be forgotten. 

The phosphorus pill is undoubtedly the best form in which to 
administer the drug, though it possesses the disadvantages of being 



ALTERATIVES. 387 

insoluble in the intestinal fluids and of producing more or less 
irritation of the gastro-intestinal mucous membrane. This latter 
effect is usually unnoticed under ordinary medicinal dosage on a 
full stomach. The liquid preparations of phosphorus are more 
unstable, rapidly tending to become inert by oxidation. 

Official Derivatives. 

Calcii Hypophosphis — Calcii Hypophosphitis— Calcium Hypophosphite 

(U.S. P.). — Origin. — Obtained by heating phosphorus with milk of lime and expos- 
ing the mixture to the air. 

Description and Properties. — Colorless, transparent, monoclinic prisms, or small, 
lustrous scales, or a white, crystalline powder ; odorless, having a nauseous, bitter 
taste, and permanent in the air. Soluble in 6.5 parts of water and in 6 parts of boil- 
ing water ; insoluble in alcohol. It should contain not less than 98 per cent, of pure 
calcium hypophosphite. 

Dose, 5-6 grains (0.3-0.4 Gm.) [7^ grains (0.5 Gm.), U. S. P.]. 

Calcii Phosphas Praecipitatus — Calcii Phosphatis Praecipitati — Precipi- 
tated Calcium Phosphate (U. S. P.).— Origin.— Prepared by the action of hydro- 
chloric acid and water upon bone-ash, the addition of solution of ammonia to render 
the mixture of an alkaline reaction, and washing and drying the precipitate. It 
should contain not less than 99 per cent, of pure calcium phosphate. 

Description and Properties. — A light, white, amorphous powder, odorless and 
tasteless, permanent in the air. Almost insoluble in cold water ; partly decomposed 
by boiling water, which dissolves out an acid salt ; almost insoluble in acetic acid, 
except when freshly precipitated ; easily soluble in hydrochloric or nitric acid ; insol- 
uble in alcohol. 

Dose, 10-30 grains (0.6-2.0 Gm. ) [15 grains (1 Gm.), U. S. P.]. 

Sodii Hypophosphis — Sodii Hypophosphitis — Sodium Hypophosphite (U. 
S. P.). — Origin. — Prepared by adding sodium carbonate to a solution of calcium 
hypophosphite and evaporating the filtrate. It should contain not less than 98 per 
cent, of pure sodium hypophosphite. 

Description and Properties. — Small, colorless, transparent, rectangular plates of a 
pearly lustre, or a white, granular powder, odorless, and having a bitterish-sweet, 
saline taste. Very deliquescent on exposure to moist air. Soluble in I part of water 
and in 30 parts of alcohol, also in 0.12 part of boiling water and in I part of boiling 
alcohol ; slightly soluble in absolute alcohol ; insoluble in ether. Sodium hypophos- 
phite should be kept in well -stoppered bottles. 

Dose, 5-10 grains (0.3-0.6 Gm.) [15 grains (1 Gm.), U. S. P.], 

Potassii Hypophosphis — Potassii Hypophosphitis — Potassium Hypophos- 
phite (U. S. P.). — Origin. — Prepared in a similar manner to calcium hypophosphite, 
or by double decomposition of calcium hypophosphite and potassium carbonate. It 
should contain not less than 90 per cent, of pure potassium hypophosphite. 

Description and Properties. — White, opaque, hexagonal plates, or crystalline 
masses, or a granular powder, odorless, and having a pungent, saline taste ; very 
deliquescent. Soluble in 0.6 part of water and in 7.3 parts of alcohol. Potassium 
hypophosphite should be kept in well- stoppered bottles. 

Dose, 5-30 grains (0.3-2.0 Gm.) [7^ grains (0.5 Gm.), U. S. P.]. 

Acidum Hypophosphorosum — Acidi Hypophosphorosi — Hypophosphorous 
Acid (U. S. P.). — Definition. — A liquid, HPH 2 2 , composed of 30 per cent, by weight 
of absolute hypophosphorous acid and 30 per cent, of water. 

Description. — A colorless, odorless liquid having an acid taste. Miscible in all 
proportions with water. It is a powerful reducing agent, precipitating metallic silver 
from solutions of silver nitrate, calomel from corrosive sublimate, etc. ; when heated 
with copper sulphate a yellow precipitate of copper hydride is formed (difference from 
phosphorous acid). It is used in the preparation of acidum hypophosphorosum 
dilutum. 

Incompatibles. — Incompatible with arsenical salts, and in general with substances 
that are more or less easily reduced. 

Acidum Hypophosphorosum Dilutum — Acidi Hypophosphorosi Diluti — 
Diluted Hypophosphorous Acid (U. S. P.). — Definition. — A liquid composed of 
10 per cent, by weight of absolute hypophosphorous acid and 90 per cent, of water. 



388 A TEXT-BOOK OF MATERIA MEDICA. 

Description and Properties. — A colorless liquid, without odor, and having an acid 
taste. Specific gravity about 1. 042. Miscible in all proportions with water. 

Dose. — It is rarely used as a therapeutic agent by itself, but in the syrup of the 
hypophosphites [8 minims (5 Cc), U. S. P.]. 

Syrupus Hypophosphitum — Syrupi Hypophosphitum — Syrup of Hypo- 
phosphites. — Formula. — Calcium hypophosphite, 45; sodium hypophospbite, 15; 
potassium hypophosphite, 15 ; diluted hypophospborous acid, 2; tincture of fresh lemon 
peel, 5 ; sugar, 650 ; sufficient water to make 1000. 

D se. — 1-2 fluidrams (4.0-8.0 Cc.) [2 fluidrams (8 Cc), U. S. P.]. 

Syrupus Hypophosphitum Compositus — Syrupi Hypophosphitum Com- 
positi — Compound Syrup of Hypophosphites (U. S. P.). — Syrupus hypophosphi- 
tum cum Ferro (U. S. P., 1890) is dropped, but this may take its place, as it contains 
iron, as ferric hypophosphite o. 25 per cent. It contains 5, calcium, potassium, sodium, 
iron and manganese, hypophosphites, hypophosphorous acid, quinine, and strychnine. 
It is adopted from the National Formulary and is similar to a number of well-known 
proprietary preparations. 

Dose. — Average dose: 2 fluidrams (8 Cc), U. S. P. 

Elixir Ferri, Quininae et Strychninae Phosphatum — Elixiris Ferri, Quininae 
et Strychninae Phosphati — Elixir of Iron, Quinine and Strychnine Phosphates. 
(U. S. P. ). — Each fluidram contains I grain (0.0647 Gm.) of ferric phosphate, \ grain 
(0.0324 Gm.) of quinine, and J ? grain (0.001 Gm.) of strychnine. This is the official 
representative of a large class of popular preparations on the market. 

Dose. — Average dose : I fluidram (4 Cc j, U. S. P. 

Glyceritum Ferri, Quininae et Strychninae Phosphatum — Glyceriti Ferri, 
Ammonias et Strychninae Phosphati— Glycerite of the Phosphates of Iron, 
Quinine, and Strychnine (U. S. P.). — This preparation is a concentrated form of 
one of the popular and useful combinations of tonics which might well replace some 
of the many proprietary preparations ; it is prepared according to a fixed and definite 
formula (see U. S. P.), whereas the latter class are made according to the special 
formulae of the different manufacturers. (See also Elixir Ferri, Quininae et Strych- 
ninae Phosphatum). This glycerite is a stable solution which may be kept in stock, 
and from which the syrup of the phosphates of iron, quinine, and strychnine may 
readily be prepared. 

Dose. — Average dose: 15 minims (1 Cc), U. S. P. I Cc. contains \\ grains 
(0.080 Gm. =80 milligrammes) of soluble ferric phosphate, if grains. (0.104 Gm. = 
104 milligrammes) of quinine, and g- 1 ^ grain (0.0008 Gm. = 0.8 milligrammes) of strych- 
nine. The ratio of quinine to strychnine is four times as great in the glycerite as in 
the elixir. 

Physiological Action. — Although not possessing the active 
and poisonous properties of phosphorus, the hypophosphites are 
useful as tonic stimulants, being particularly valuable in general 
furunculosis. 

The calcium phosphate adds the action of calcium to that of 
the hypophosphite. 

The zinc phosphide is more active. In this preparation the 
:zinc ion plays an important part. 

Therapeutics. — Externally and Locally. — The calcium phos- 
phate, combined with a little free phosphoric acid, has been recom- 
mended by Doubcnski in the treatment of tuberculous ulcerations. 
"Cold abscesses and fistulous tracts were treated by packing with 
gauze soaked with a solution of 5 parts to 100." 

Internally. — The hypophosphites are useful as general tonics. 
Phosphoric acid has little action as determined by animal experi- 
mentation, but negative evidence from such research has no bear- 
ing, in view of much positive evidence derived from clinical use. 
In chlorosis, anemia y scrofula, and tuberculosis they have been highly 
recommended. In the opinion of many the benefit derived from 



AL TERA TIVES. 389 

their use in the cachexias mentioned is slight compared with that 
of cod-liver oil and the hygienic influences rendered serviceable in 
these conditions. 

The zinc phosphide, according to some observers, has medicinal 
virtues greatly superior to those of other preparations, but these 
results are disappointing. 

Administration. — The zinc phosphide is best given in pill form. 
The hypophosphites and calcium phosphate may be given in cap- 
sules, though the syrup of the hypophosphites is usually preferred. 
In patients who cannot take sugar, even in small quantities, the 
syrup may be contraindicated. 

ARSENIC 

Arseni Trioxidum— Arseni Trioxidi— Arsenic 
Trioxide. TJ. S. JP. 

(Acidum Arsenosum. U. S. P., 1890.) 

Origin. — Arsenic has been found in minute proportions in many mineral waters. 
It is obtained in large quantities by roasting arsenical ores — cobalt, nickel, tin, and 
particularly arsenical iron pyrites — and purifying by resublimation. It should contain 
not less than 99.8 per cent, of pure arsenic trioxide. 

Description and Properties. — It is a heavy solid, occurring either as an 
opaque white powder or in irregular masses, of two varieties — the one, amorphous, 
transparent, and colorless, like glass ; the other, crystalline, opaque, or white, resem- 
bling porcelain. Frequently the glassy variety is found enclosed in an opaque, white 
crust. Contact with moist air changes the glassy into the white, opaque variety. Both 
are odorless and tasteless. 

Both varieties dissolve very slowly in cold water, the glassy variety requiring about 
30, the porcelain-like about 100, parts of water at 25 C. (77 F.). Both are slowly 
but completely soluble in 15 parts of boiling water. Arsenous acid is but slightly sol- 
uble in alcohol, but is soluble in about 5 parts of glycerin. Oil of turpentine dissolves 
the glassy variety only. Both varieties are freely soluble in hydrochloric acid and in 
solutions of alkali hydrates and carbonates. 

Dose. — sVVff & rain (0.001-0.003 Gm.) [3^ grain (0.002 Gm.), U. S. P.]. 

Official Preparations. 

Liquor Acidi Arsenosi — Liquoris Acidi Arsenosi — Solution of Arsenous 
Acid. — Strength, 1 per cent, of arsenic trioxide. 

Description and Properties. — A clear, colorless liquid, odorless, having an acidulous 
taste and an acid reaction. 

Dose. — 2-10 minims (0.12-0.6 Cc.) [3 minims (0.2 Cc), U. S. P.]. 

Liquor Potassii Arsenitis — Liquoris Potassii Arsenitis — Solution of Potas- 
sium Arsenite (Fowler's Solution). — Strength, 1 per cent, of arsenic trioxide. 

Dose. — 2-10 minims (0.12-0.6 Cc.) [3 minims (0.2 Cc), U. S. P.]. 

Arseni Iodidum— Arseni Iodidi-Arsenic Iodide. 

TJ. S. P. 

Origin. — Prepared by triturating in a mortar finely powdered metallic arsenic and 
iodine until they are thoroughly mixed ; or by mixing solutions of arsenous and hydri- 
odic acids, and evaporating. It should contain not less than 82.7 per cent, of iodine 
and 16.3 per cent, of metallic arsenic. 

Description and Properties. — Glossy, orange-red, crystalline masses, or 
shining, orange-red, crystalline scales, having an iodine-like odor and taste ; gradually 
losing iodine on exposure to air and light. Soluble in 12 parts of water and in about 
28 parts of alcohol. Arsenic iodide should be kept in glass-stoppered vials, in a cool 
place, protected from light. 

Dose. — ^V~i g ram (0.002-0.008 Gm, ) [ T ^ grain (0.005 Gm.), U. S. P.]. 



390 A TEXT-BOOK OF MATERIA MEDICA. 

Official Preparation. 

Liquor Arseni et Hydrargyri Iodidi — Liquoris Arseni et Hydrargyri Iodidi 
— Solution of Arsenic and Mercuric Iodide — (Donovan's Solution). — Strength: 
I per cent., each, arsenic iodide and mercuric iodide. 

Description and Properties. — A clear, pale-yellowish liquid, without odor, and having 
a disagreeable metallic taste. 

Dose. — i-io minims (0.06-0.6 Cc.) [4^ minims (i Cc), U. S. P.]. 

Sodii Arsenas— Sodii Arsenatis— Sodium Arsenate. 

77. S. JP. 

Origi n — Prepared by heating to redness arsenous acid, sodium nitrate, and sodium 
carbonate. Dissolve the fused mass in water and crystallize. Dissolve crystals in water 
and recrystallize. It should contain not less than 98 per cent, of pure di-sodium- 
orthoarsenate. 

Description and Properties. — Colorless, transparent, monoclinic prisms, 
odorless, and having a mild, alkaline taste (the salt is very poisonous). Efflorescent in 
dry air, and somewhat deliquescent in moist air. Soluble in 1.2 parts of water, very sol- 
uble in boiling water, and slightly soluble in cold water. Soluble in 60 parts of boiling 
alcohol. Sodium arsenate should be kept in well-stoppered bottles. 

Dose. — g*g — rV grain (o.ooi-o.od6 Gm.) [ T 5 „ grain (0.005 Gm.),U. S. P.]. 

Sodii Arsenas Exsiccatus— Sodii Arsenatis Exsiccati 
—Exsiccated Sodium Arsenate. TJ. S. P. 

(Also known as Anyhydrous Sodium Arsenate.) 

Description and Properties. — An amorphous, odorless, white powder, 
Na 2 HAs0 4 . Permanent in dry air. Soluble in 3 parts of water ; very soluble in boil- 
ing water. 

This is prepared from sodium arsenate by expelling by heat the seven molecules of 
water of the latter. The hydrous sodium arsenate (sodii arsenas, U. S. P.) is efflores- 
cent in dry air and somewhat deliquescent in moist air; hence the percentage of arsenic 
is somewhat uncertain. The new preparation is permanent in dry air. The hydrous 
sodium arsenate contains 40.4 per cent, of water; hence, a given weight of this substance 
will contain but little more than half as much arsenic as an equal weight of the exsic- 
cated. The average dose of the latter is accordingly placed at about one-half that of the 
former. 

Dose. — Average dose : ^ grain (0.003 Gm. = 3 milligrammes), U. S. P. 

Official Preparation. 

Liquor Sodii Arsenatis — Liquoris Sodii Arsenatis — Solution of Sodium 
Arsenate — (Pearson's Solution). — Strength : 1 percent, of sodium arsenate. 
Dose. — 1-10 minims (0.06-0.6 Cc.) [3 minims (0.2 Cc ), U. S. P.]. 

Antagonists and Incompatibles. — Arsenic is incompatible with 
the salts of iron, silver, magnesia, lime, copper, ammonium, and 
with vegetable astringents. 

Synergists. — Iron and general tonics are synergistic to arsenic. 

Physiological Action. — Externally and Locally. — Arsenic itself 
is largely inert. It is partially oxidized, however, particularly in 
the intestinal canal, and the arsenous acid ion H 3 As0 3 and the 
anhydride, As 2 3 , are converted into arsenites and are active. 
Applied to the skin, arsenic acts as a caustic, exciting violent inflam- 
mation. Its escharotic influence results in destruction of vitality in 
the affected parts, accompanied with sloughing. Arsenic may be 



AL TERA TIVES. 391 

absorbed from the unbroken skin. Skin eruptions are frequent under 
arsenical applications. 

Internally. — Digestive System. — Except in exceedingly small 
doses arsenic acts as a gastro-intestinal irritant. Minute and me- 
dicinal doses stimulate the flow of gastric and intestinal juices, and 
augment peristalsis, improving the digestive and nutritive functions. 
When too long continued, the drug produces nausea, diarrhea, and 
increased micturition, with a sensation of heat and dryness of the 
throat and stomach. Toxic doses are followed by violent gastro- 
enteritis. Indeed, in whatever manner introduced into the system, 
arsenic has a marked action upon the gastro-intestinal tract, caus- 
ing vascular changes, in the nature of dilatation of the capillaries, 
which when prolonged bring about destructive lesions. (See 
Chronic Poisoning.) 

Nervous System. — The general effect of arsenic upon the brain 
and nervous system is that of a tonic. The cerebral functions are 
somewhat stimulated. 

The grade of stimulation caused by arsenic is difficult to deter- 
mine, as other factors, notably its action on the skin and blood, 
should be borne in mind. In chronic poisoning (q. v.), even from 
very minute doses, the nervous system is markedly affected, par- 
ticularly the peripheral nerves, both motor and sensory. 

Under prolonged use arsenic tends to accumulate to a greater 
extent in nervous than in other tissues. Thus, according to 
Scolosuboff, if 1 part is found in fresh muscle, the proportion in 
the liver is 10.8 ; in the brain, 36.5 ; in the spinal cord, 37.3. 

Circulatory System. — Cardiac action may be slightly stimulated 
by small doses, the experience of arsenic eaters proving that the 
drug, so far from being necessarily deleterious, actually tends to 
invigorate the heart action for a time at least. Large doses render 
the heart irritable and feeble. 

On the blood-making organs, arsenic has a distinct action, though 
as yet not definitely understood. New-formed blood-cells have 
been found, and the spleen and long bones seem to be stimulated 
to increased blood-making activity. Arsenic in its relations to 
chronic poisoning shows itself to have a destructive action on the 
minute blood-vessels. It seems, in common with many other sub- 
stances, to increase the clotting properties of the blood-serum. 
Capillary thrombi are constant features of chronic toxemia. 

Respiratory System. — Ordinary amounts effect no special change 
in respiration other than increased power and stimulation of the 
respiratory center. It has been held, with authority, that small 
doses stimulate the peripheral endings of the pulmonary vagi. In 
toxic doses arsenic acts as a powerful respiratory depressant. 

Absorption and Elimination. — Arsenic is readily absorbed by 
the blood. Its presence has also been detected in the viscera, bile, 
urine, sweat, the bronchial and intestinal mucous membranes, and 
even in the parenchymatous tissues. It is eliminated slowly from 
the body by the intestines, and rapidly by the urine ; possibly, 



392 A TEXT-BOOK OF MATERIA MEDICA. 

also, by the bile and the skin. The saliva, milk, and even the 
tears are said to share in the process of elimination. 

Medicinal doses prevent tissue-change, while large doses in- 
crease nitrogenous metamorphosis. The therapeutic action is cer- 
tainly to modify and improve nutrition. Binz has suggested the 
novel idea that the main activity of arsenic is due to its peculiar 
oxidizing properties by which arsenous acid is oxidized to arsenic 
acid, which in turn is reduced to arsenous acid, etc. Thus the 
alternating oxidation and reduction would account for its stimula- 
ting general metabolic activity. 

Temperature. — The temperature is unaffected by medicinal doses. 
Chronic intoxication may be accompanied by a rise in temperature. 

Eye. — Large doses, or small doses repeated, are followed by 
injection of the conjunctivae, eczema, inflammation, and edema of 
the lids. This is a manifestation of the general engorgement of 
the capillaries of the gastro-intestinal and respiratory tract mucosa. 

Untoward Action. — Differing from the characteristic symptoms 
of poisoning occasionally produced by medicinal doses in very 
susceptible persons, there are induced, not infrequently, restless- 
ness, headache, alopecia areata, bronchitis, hoarseness, disturbances 
of digestion, thirst, coryza, and, in rare cases, epistaxis, anaphro- 
disia, icterus, lacrimation, photophobia, amblyopia, dermatitis, and 
various cutaneous eruptions, frequently followed by desquamation. 

An eruption resembling that of measles, produced by 3 drops 
(0.18 Cc.) of Fowler's solution, is reported by Macnal {Medical 
Times and Gazette, 1868). Falck reports a case in which arsenic 
produced a discolored sanguinolent eruption with erysipelatous 
swelling. Papules and erythematous pustules have also been 
observed. 

" Eruptions petechial or ecchymotic, eruptions papular, vesicular, 
erysipelatous, pustular — such are the principal forms of arsenical 
exanthemata," described by Imbert-Gourbeyre. 

Poisoning. — Large doses of arsenic taken in the form of rat 
poisons, fly papers, dyes, and parasiticides fScheele's and Paris 
green) produce symptoms of acute poisoning, the drug almost 
immediately manifesting its characteristic effects upon the gastro- 
intestinal canal (to which it is a marked irritant), exciting active 
inflammation. There are, in from fifteen minutes to one-half hour, 
colicky pains in the stomach, nausea, vomiting, looseness of the 
bowels, and edema of the face, indicated by pufriness under the 
eyelids. The passages are at length similar to the " rice-water " 
discharges of cholera, although different from the latter in the 
presence of blood or serum. The purging becomes obstinate and 
exhausting. In certain cases other choleraic symptoms are espe- 
cially manifested, as increasing coldness of the body, and cramps. 

There is great prostration, pinched, bloodless face, fall in blood- 
pressure, the urine is scanty or suppressed, headache, collapse. 
Death may supervene in from one to four hours with small pulse 
and sighing respiration. Sometimes the patient recovers from the 



AL TERA TI VES. 393 

acute attack, and subsequently dies in from two to three days from 
the secondary degeneration, as in phosphorus-poisoning. As a 
minimum lethal dose, I grain (0.06 Gm.) of arsenous acid may be 
mentioned as having caused death, though much larger doses have 
been recovered from. 

Chronic Poisoning. — This may arise from a great variety of 
sources. In some localities by some peoples, as in Styria, large 
doses are tolerated for considerable periods of time, apparently 
with not markedly pernicious effects. Undoubtedly, much of the 
fame of the arsenic eaters' good health is fictitious, but the clinical 
evidence goes to show that a tolerance for arsenic may be estab- 
lished. 

In chronic poisoning, which may arise from the absorption of 
very minute amounts of arsenic from earths, food, fruit sprays, 
paints, wall-paper, carpets (dyed with arsenic dyes), beer (arsenic 
from glucose, from sulphuric acid), the symptoms may be in (1) 
Intestinal tract — anorexia, nausea, sometimes vomiting, occasional 
diarrhea, pain ; (2) Mucous membranes of eye, nose, throat, as 
coryza, sneezing, conjunctivitis, puffiness of eyelids ; (3) Skin — 
as eruptions, pigmentation, herpes, increased growth of hair and 
nails ; (4) Nervous System, as paresthesias, followed by peripheral 
neuritis of arms or legs, or both, neuralgic pains usually accom- 
panying. In terminal stages, mental symptoms, as dementia, with 
convulsive seizures, etc., may develop. 

Treatment of Poisoning. — In the acute poisoning it is necessary 
that treatment be expeditious, and the agents and methods adopted 
carefully chosen. Vomiting often renders the use of the stomach- 
pump unnecessary, yet emetics are frequently serviceable, the 
cleansing of the stomach being of primary importance. Various 
antidotes have been successfully used, the best, chemically, being 
freshly prepared hydrated sesquioxide of iron, administered in 
water, 2 or 3 tablespoonfuls every fifteen or twenty minutes. 
Magnesia, chalk, and lime-water also serve as efficient antidotes. 
The temperature of the patient should be maintained, and demul- 
cents (oil, milk, etc.) freely given. The after-treatment should 
include mucilaginous drinks, opiates if indicated, cathartics, and, in 
case of necessity, stimulants. Active vessel tonics, as ergot, adren- 
alin, etc., may be useful to overcome the collapse. 

In the chronic poisoning, withdrawal of the arsenic and general 
symptomatic treatment is indicated. 

Therapeutics. — Externally and Locally. — The chief use of 
arsenic locally is as an escharotic. For this purpose it is employed 
to destroy malignant growths, such as cancer, sarcoma of the skin, 
and multiple sarcomatous degeneration of the lymphatic glands. In 
the latter affection the parenchymatous injection of 5 minims 
(0.3 Cc.) of Fowler's solution, diluted with twice the amount of 
distilled water, is used. 

Many of the pastes and " quack " cancer remedies owe most of 
their efficiency to arsenic. Manec's paste contains arsenous acid, 



394 A TEXT-BOOK OF MA TERIA MEDICA. 

15 grains (1.0 Gm.); black sulphide of mercury, 75 grains (5.0 
Gm.); burnt sponge, 35 grains (2.3 Gm.). 

The noted poudre caustique de Frere Cdsme ou du Rousselot is a 
similar preparation, containing about the same quantity of arsenic. 

The solution of arsenous acid is an excellent local application 
to warts and corns. If these growths are very firm and horny, 
their removal may be facilitated by the previous application of 
solution of potassa. When used over large surfaces arsenic should 
be applied in good strength and heroically, so that active inflam- 
mation may be excited and the danger of absorption lessened. 

Internally. — Arsenic is a peculiarly efficient remedy in clironic 
scaly skin diseases. 

Like all other alteratives, it influences diseases of a chronic 
nature more favorably than acute disorders, invariably aggravating 
acute skin diseases. This drug, therefore, is one of the most valued 
remedies in psoriasis , lepra, and chronic squamous eczema. 

Pemphigus, prurigo, acne, and lichen ruber have often been favor- 
ably influenced by the continued administration of Fowler's solu- 
tion. In the successful management of these chronic skin diseases 
it is necessary that the preparation of arsenic employed be given in 
as large doses as can be tolerated by the patient, and the treatment 
continued unremittingly for a long period. 

Lymphoma, whether superficial or occupying the great cavities, 
is frequently benefited greatly by similar treatment. 

Asthma and bronchitis, whether acute or chronic, accompanying 
or succeeding scaly skin diseases, are singularly amenable to this 
medicine when the dose is carried to the full physiological limit. 
Another condition, dysmenorrhea, frequently noticed in women with 
a tendency to asthma or subject to chronic diseases of the skin, is 
often cured or greatly benefited by arsenic. 

The obstinate and often incurable disease known as pernicious 
anemia yields better to arsenic than to any other known remedy. 

The statements in the preceding paragraph apply also to leu- 
kemia, whether splenic, myelogenic, or lymphatic, and to Hodgkiris 
disease. 

Arsenic is valuable in the treatment of malaria, particularly in 
the chronic cachectic types. The modus operandi is not yet known. 
It may be a protozoa poison, or it may increase certain protective 
properties of the blood-sera. It may have an action on the spleen. 

The neuralgias, anemia, and headache of malarial origin are 
singularly amenable to this medicine. 

Fowler first reported the remarkable efficacy of arsenic in 
neuralgia of the intercostal and fifth pair of nerves. It is equally 
valuable in these cases whether the disease be due to malaria or 
to general debility. 

If this drug is specific in any one disease, it is so in chorea, 
very rarely failing to effect a cure when judiciously administered. 
It should be given in full doses, and increased as tolerance is 
established. 



AL TERA TIVES. 395 

This medicine seems to act equally well in gastralgia. It is also 
an efficient remedy in gastritis or the vomiting of gastritis, espe- 
cially in that occasioned by the excessive use of alcohol. Many 
irritative conditions of the stomach are relieved by minute doses of 
Fowler's solution. Excessive peristalsis, resulting in diarrhea, 
coming on immediately after taking food, is usually cured com- 
pletely by very small doses of Fowler's solution, alone or com- 
bined with an equal quantity of tincture of opium. Arsenic has 
also been recommended in gastric ulcer and cancer. 

It has proved of great service in hay fever, spasmodic asthma, 
and acute coryza. It is often very serviceable in catarrhal pneu- 
monia and in chronic bronchitis. Arsenic is useful in diabetes mellitus. 
Rheumatoid arthritis is more favorably influenced by the use of 
arsenic than by any other medicine. It should be employed in the 
treatment of chronic rheumatism. Even in secondary syphilis a com- 
bination of mercury and arsenic has produced better results, in 
some cases, than mercury alone. Anstie has recommended arsenic 
in angina pectoris, alleging that it mitigates the severity of the 
attacks. Chronic diarrhea, when induced by intestinal fermenta- 
tion or chronic malarial infection, is sometimes greatly benefited by 
this drug. 

Finally, arsenic is a valuable adjunct to iron in the treatment of 
simple anemia and chlorosis. 

Contraindications. — In acute skin diseases and pulmonary 
tuberculosis with a tendency to hemoptysis. 

Administration. — Arsenic should be given ordinarily after 
meals. There are certain conditions, however, requiring its admin- 
istration in small doses before meals. When it is desired to give 
arsenic in pill form, the trioxide should be used ; and for solutions 
the liquor potassii arsenitis is usually preferred. 

In syphilitic disorders Donovan's solution is an excellent prepa- 
ration to use. 

Children are much less susceptible to the drug than adults, 
often being able to take adult doses with impunity. 

During a course of arsenic the patient should be instructed to 
watch carefully for the first untoward manifestations, such as puffi- 
ness about the eyes, itching of the conjunctivae, nausea, diarrhea, 
or numbness of the fingers. Any one of these symptoms is an 
indication that the dose should not be increased ; and it may be 
necessary to lessen the dose, or even to discontinue the remedy 
altogether, for a while. 

There are two methods of getting a patient thoroughly under 
the influence of the drug : 

1. Begin with a full dose of Fowler's solution, and decrease I 
minim (0.06 Cc.) a day until a 1 -minim (0.06 Cc.) dose is reached ; 
then repeat the method. 

2. Begin with a small dose of Fowler's solution, and increase 
I minim (0.06 Cc.) a day until untoward symptoms appear or 
the dose has reached 10 to 15 minims (0.6-1.0 Cc.) ; then either 



396 A TEXT-BOOK OF MATERIA MEDIC A. 

repeat the method or decrease the amount I minim (0.06 Cc.) 
a day. 

Cacodylates. — Organic compounds of arsenic are claimed to 
act much more slowly and less actively than the inorganic com- 
pounds. Such compounds are cacodylic acid and sodium caco- 
dylate, which have been introduced into modern therapy, although 
first suggested by Schmidt in 1869. It is extensively claimed that 
these bodies are non-irritating, but this is not the fact, although 
clinical experience would seem to show that much larger doses of 
arsenic can be taken as cacodylates than in any other form. The 
indications are the same as those in ordinary arsenic therapy. 
Dosage, \-\ grain. Renz in 1865 obtained poisonous effects from 
doses of from 10 to 18 grains of cacodylic acid. French observers 
maintain that the hypodermic use of the cacodylates gives different 
results than when they are given by mouth. 

Hydrargyrum— Hydrargyri— Mercury. 77. S. P. 

(Quicksilver.) 

Origin. — The knowledge of this drug antedates the Christian era. It is found 
in Spain, Austria, Peru, and China, but is obtained principally from New Almaden, 
California. It occurs to some extent in the metallic state in the form of minute or 
large globules ; also in combination with oxygen, chlorine, selenium, etc. ; but the 
principal ore from which it is extracted is cinnabar. 

Description and Properties. — A shining, silver- white metal, without odor 
or taste. It is liquid at the ordinary temperature, and easily divisible in spherical 
globules; but when cooled to — 39. 38 C. ( — 3S.88 F.), it forms a ductile, mal- 
leable mass. Specific gravity, 13.535 at 2 5° C- (77 F. ). 

Insoluble in the ordinary solvents, also in concentrated hydrochloric acid, and, at 
common temperatures, in sulphuric acid, but dissolving in the latter when boiled with 
it, and readily and completely soluble in nitric acid. Mercury should be kept in strong, 
well-stoppered bottles. 

Dose. — Mercury is seldom given internally except in the modified form of blue 
pill. 

Official Derivatives. 

Hydrargyrum Ammoniatum — Hydrargyri Ammoniati — Ammoniated Mer- 
cury [V. S. P.). — Origin. — Prepared by mixing solutions of ammonia and corrosive 
mercuric chloride. Filter and wash the precipitated ammoniated mercury'. It should 
contain not less than 78 per cent., nor more than 80 per cent., of metallic mercury. 

Description and Properties. — White, pulverulent pieces, or white, amorphous pow- 
der, without odor, and having an earthy, and afterward styptic and metallic taste. 
Permanent in the nir. Almost insoluble in water or in alcohol. It should be kept 
in well-stoppered bottles, protected from the light. Used externally. 

Unguentum Hydrargyri Ammoniati — Unguenti Hydrargyri Ammoniati — 
Ointment of Ammoniated Mercury. — Formula: Ammoniated mercury, 10 ; white 
petrolatum, 50; hydrous wool-fat, 40. For external use. 

Hydrargyrum cum Creta— Hydrargyri cum Creta — Mercury with Chalk 
(U. S. P.). — Origin. — Obtained by trituration of mercury, prepared chalk, clarified 
honey, and water. 

Description and Properties. — A light-gray, rather damp ] owder, free from gritti- 
ness, without odor, and having a slightly sweetish taste. It contains 38 per cent, of 
mercury. This preparation should be kept in well -stoppered bottles, protected from 
light. 

Dose, 3-10 grains (o. 18-0.6 Gm.) [4 grains 10.2^ Cm.). U. S. P.]. 

Massa Hydrargyri — Massae Hydrargyri — Mass of Mercury (U. S. P.). 
(Pilula lIvnkAKGVRi — Blue Mass — Blue Pill). — Composed of mercury, glycyr- 
rhiza, althaea, glycerin, and honey of rose. 

Do •-, J-IO grains (0.03-06 Cm.) [4 grains (0.25 Cm. , U. S. P.]. 



ALTERATIVES. 397 

Unguentum Hydrargyri — Unguenti Hydrargyri — Mercurial Ointment (U. 
S. P.). — Composition: Mercury, lard, suet, and oleate of mercury. Used externally. 

Unguentum Hydrargyri Dilutum — Unguenti Hydrargyri Diluti — Blue 
Ointment (U. S. P.). — This preparation contains 67 per cent, of unguentum hydrar- 
gyri, which is called mercurial ointment. Heretofore " Blue Ointment" and '"Mer- 
curial Ointment " have been synonymous. Mercurial ointment contains about 50 per 
•cent, of metallic mercury, while blue ointment contains about 33.5 per cent. 

Emplastrum Hydrargyri — Emplastri Hydrargyri — Mercurial Plaster (U. 
:S. P.). — Composition : Mercury, oleate of mercury, hydrous wool-fat, and lead plaster. 
Used externally. 

Hydrargyri Chloridum Corrosivum — Hydrargyri Chloridi Corrosivi — Cor- 
rosive Mercuric Chloride (U. S. P.) (Corrosive Chloride of Mercury — Corro- 
sive Sublimate). — Origin. — Prepared by heating a mixture of mercuric sulphate, 
sodium chlorate, and manganese dioxide. The corrosive chloride sublimes and is con- 
densed. It should contain not less than 99.5 per cent, of pure mercuric chloride. 

Description and Properties. — Heavy, colorless, rhombic crystals or crystalline 
masses ; odorless and having an acrid and persistent metallic taste. Permanent in the 
air. Soluble in 13 parts of water, in 3 parts of alcohol, in 2 parts of boiling water, in 
1.2 parts of boiling alcohol, in 4 parts of ether, and in about 14 parts of glycerin. It 
should be kept in well-stoppered bottles. 

Dose. — J ¥ -i grain (o.coi-0.008 Gm.) [^L grain (0.003 Gm.), U. S. P.]. 

Hydrargyri Chloridum Mite — Hydrargyri Chloridi Mitis — Mild Mercurous 
Chloride (U. S. P.) (Calomel — Mild Chloride of Mercury). — Origin. — Obtained 
by triturating mercuric sulphate, mercury, sodium chloride, and boiling distilled water. 
Sublime, and wash the sublimed calomel with boiling distilled water. It should contain 
not less than 99.5 per cent, of pure mercurous chloride. 

Description a?td Properties. — A white, impalpable powder, becoming yellowish- 
white on being triturated with strong pressure. It is odorless and tasteless, and per- 
manent in the air. Insoluble in water, alcohol, or ether, and also in cold diluted acids. 
When strongly heated it is wholly volatilized, without melting. Calomel should be kept 
in dark, amber-colored bottles. 

Dose. — g-V-io grains (0.002-0.6 Gm.) [1-2 grains (0.065-0.125 Gm.), U. S. P.]. 

Piluke Catharticae Compositae— Pilulas (ace.) Catharticus Compositas— 
Compound Cathartic Pills. — Dose, 1 to 3 pills. 

Hydrargyri Iodidum Flavum— Hydrargyri Iodidi Flavi— Yellow Mercurous 
Iodide (U. S. P.) (Hydrargyri Iodidum Yiride— Protiodide of Mercury— Yel- 
low (or Green) Iodide of Mercury).— Origin.— Prepared by mixing solutions of 
potassium iodide and mercurous nitrate with nitric acid and distilled water. The pre- 
cipitate is washed and dried. It should contain not less than 99.5 per cent, of pure 
mercurous iodide. 

Description and Properties. — A bright-yellow, amorphous powder, odorless and 
tasteless. By exposure to light it becomes darker in proportion as it undergoes decom- 
position into metallic mercury and mercuric iodide. Almost insoluble in water, and 
wholly insoluble in alcohol or ether. It should be kept in dark, amber-colored vials, 
with the least possible exposure to light. 

Dose. — l-i grain ( 0.0 1 -o. Of. Gm.) [-£ grain (o.oi Gm.), U. S. P.]. 

Hydrargyri Iodidum Rubrum— Hydrargyri Iodidi Rubri— Red Mercuric 
Iodide (U. S. P.) (Biniodide of Mercury— Red Iodide of Mercury).— Origin.— 
Prepared by mixing solutions of corrosive mercuric chloride and potassium iodide ; filter, 
and dry the precipitated red iodide. It should contain not less than 99.5 per cent, of 
pure mercuric iodide. 

Description and Properties. — A scarlet-red, amorphous powder, odorless and taste- 
less ; permanent in the air. Almost insoluble in water, but soluble in 130 parts of 
alcohol. It should be kept in well-stoppered bottles, protected from light. 

Dose. — j2~Te £ ram (0.002-0.004 Gm.) [^ grain (0.003 Gm.), U. S. P.]. 

Liquor Arseni et Hydrargyri Iodidi— Liquoris Araeni et Hydrargyri Iodidi 
—Solution of Arsenic and Mercuric Iodide.— (Described under Arsenic.)— Dose, 
5 minims (0.3 Cc), graduallv increased. 

Hydrargyri Oxidum Flavum— Hydrargyri Oxidi Flavi— Yellow Mercuric 
Oxide (U. S. P.). — Origin. — Prepared by precipitating a solution of corrosive mercuric 
chloride with soda. It should contain not less than 99.5 per cent, of pure yellow mer- 
curic oxide. 

Description and Properties. — A light orange-yellow, amorphous, heavy, impalpable 
powder ; odorless, and having a somewhat metallic taste. Permanent in the air, but 



398 A TEXT-BOOK OF MATERIA MEDIC A. 

turning darker on exposure to light. Almost insoluble in water or in alcohol. It should 
be kept in well-stoppered bottles, protected from light. Not used internally. 

Unguentum Hydrargyri Oxidi Flavi — Unguenti Hydrargyri Oxidi Flavi — 
Ointment of Yellow Mercuric Oxide. — Formula: Yellow mercuric oxide, io ; 
water, io ; hydrous wool-fat, 40; petrolatum, 40. Used externally. 

Hydrargyri Oxidum Rubrum — Hydrargyri Oxidi Rubri — Red Mercuric 
Oxide (U. S. P.) (Red Precipitate). — Origin. — Prepared by dissolving mercury in 
diluted nitric acid. Evaporate to dryness. Triturate the mercuric nitrate thus formed 
with mercury and heat. It should contain not less than 99.5 per cent, of pure red mer- 
curic oxide. 

Description and Properties. — Heavy, orange-red crystalline scales, or a crystalline 
powder, becoming yellower the finer it is divided ; odorless, and having a somewhat 
metallic taste ; permanent in the air. Almost insoluble in water and in alcohol. It 
should be kept in well-stoppered bottles, protected from light. 

Dose. — sVtV & ram (0.001-0.006 Gm. ). 

Unguentum Hydrargyri Oxidi Rubri — Unguenti Hydrargyri Oxidi Rubri — 
Ointment of Red Mercuric Oxide. — Formula : Red mercuric oxide, 10 ; water, 10 ; 
hydrous wool-fat, 40; petrolatum, 40. Used externally 

Liquor Hydrargyri Nitratis— Liquoris Hydrargyri Nitratis — Solution of 
Mercuric Nitrate (U. S. P. ). A liquid containing about 60 per cent, of mercuric 
nitrate, together with about 11 per cent, of free nitric acid. 

Description and Properties — A clear, nearly colorless, heavy liquid, having a faint 
odor of nitric acid and a strongly acid reaction. The product should be kept in glass- 
stoppered bottles. 

Used externally as a caustic. 

Unguentum Hydrargyri Nitratis — Unguenti Hydrargyri Nitratis — Oint- 
ment of Mercuric Nitrate (U. S. P.) (Citrine Ointment). — Formula: Mercury, 
70; nitric acid, 175; lard, 760 parts. Used externally. 



Unofficial Preparations. 

Lotio Flava — Lotionis Flavae — Yellow Wash. — Corrosive sublimate, 25 grains 
(0.5 Gm. ), in lime water, 16 ounces (473.17 Cc ). For external use. 

Lotio Nigra— Lotionis Nigrae — Black Wash. — Calomel, 64 grains (4.15 Gm.), 
in lime water, 16 ounces (473.17 Cc). For external use. 

Asparagin Hydrargyrate. — Dose. — \ grain (0.01 Gm.), hypodermically. 

Antagonists and Incompatibles. — Mercury with chalk is in- 
compatible with acids and acidulous salts. Calomel is incompatible 
with alkalies, alkaline earths, alkaline carbonates, iron, lead, copper, 
iodine, bromides, soaps, sulphydrates, and nitrohydrochloric acid, 
as well as hydrochloric acid, potassium, ammonium, and sodium 
chloride. 

Corrosive sublimate is incompatible with alkalies and their car- 
bonates, soap, lime water, tartar emetic, the iodides of potassium 
and sodium, acetate of lead, silver nitrate, the sulphides, albuminous 
liquids (as milk, etc.), many vegetable infusions, and compound 
syrup of sarsaparilla. 

In general, metallic preparations of mercury are incompatible 
with iodine and the chlorides. 

Synergists. — Potassium iodide enhances the antisyphilitic action 
of mercury. Depressants — such as antimony and alkalies — increase 
the physiological activity of mercury and its preparations. 

Tonic and resin-bearing purgatives — such as aloes, rhubarb, 
and podophyllum — aid the cathartic action of some of the mercurial 
preparations. 

Physiological Action. — Externally and Locally. — Most of the 



AL TERA TI VES. 399 

preparations applied to the skin are antiparasiticide and antiseptic, 
corrosive mercuric chloride being one of the most important anti- 
septics and universal germicides known. 

Some of the mercurials are powerful irritants, the nitrate being 
an active caustic. The mercurous salts even possess slightly 
stimulating properties. 

Metallic mercury and its salts are readily absorbed with the aid 
of friction, at times producing a slight irritation resulting from their 
stimulating properties. Absorption may also take place from local 
application in the form of a fine vapor. 

The introduction of the drug into the system through the 
medium of the skin is attended with all the symptoms of mercurial 
poisoning. The local actions of the various preparations differ 
somewhat, yet they agree in certain physiological effects produced 
after absorption of the drug. 

Locally, on mucous membranes, mercury acts as an astringent 
or cauterizant, according to the salt used and the grade of concen- 
tration. The mercury ion has a marked affinity for albumin, coag- 
ulating it. The coagulum is usually light and flocculent, and the 
action of the metal is thus made more penetrating. In contact 
with mucous membranes an albuminate is formed which is very 
soluble in an excess of proteid. Thus absorption is rapid. 

Internally. — Digestive System. — The action of the soluble and 
insoluble salts is distinct. The line between physiological action 
and toxic action is difficult to draw. The soluble salts are, even in 
minute doses, somewhat astringent or even corrosive. In larger 
doses they are powerfully escharotic. The action of soluble salts 
of mercury is to slightly inhibit the digestive processes. The insoluble 
salts are slightly irritating and cause increased peristalsis, and in- 
creased secretions. They have little action on the digestive ferments. 

Nervous System. — Tonic doses have little effect. There may be 
some erethrism, muscular tremor, and slight peripheral signs pre- 
ceding the development of more distinct toxic effects. 

Circulatory System. — Mercury in small doses has little action 
on the heart or vessels. The blood-making organs are stimulated 
by small doses, resulting in an increase of hemoglobin and of red 
cells. In lower animals a pseudo-antitoxic power has been demon- 
strated. Physiological stimulation soon passes over into toxic 
action with cachexia, leucocytosis, and other poisonous symptoms 
(a. v). 

Respiratory System. — Small doses are not known to affect the 
respiratory action. 

Excretion and Secretion. — The kidney epithelium is somewhat 
irritated by mercury. Diuresis is common. 

The absorption of mercury is gradual ; yet, notwithstanding the 
fact that every secretion of the body contributes to its general 
expulsion from the system, its cumulative action is a well-estab- 
lished fact. 

Elimination occurs chiefly by the urine, the saliva, bile, sweat, 



400 A TEXT-BOOK OF MA TERIA MEDICA. 

milk, and feces. Even the semen shares in the process. Single doses 
may be eliminated in twenty-four hours, but the drug has been 
detected in the liver a year after the discontinuance of prolonged 
treatment. Mercury has been found in serum and in pus from 
ulcers. After death the kidneys and liver contain the largest 
amounts of the metal. 

Untoward Action. — Many affections of the skin manifest them- 
selves after the exhibition of mercury, erythema and eczema (eczema 
mercuriale) frequently occurring after either the ingestion or the 
external application of mercurial preparations. 

In certain persons having an idiosyncrasy regarding this drug, 
extreme salivation and stomatitis may be induced by the internal 
use or the external application of mercurial preparations in medici- 
nal quantities. 

Medicinal doses may produce, in susceptible persons, marked 
disturbances of nutrition, sensation, and motion to such a degree 
as to suggest poisoning. 

Poisoning. — Although mercury in a metallic state is compara- 
tively innocuous, its vapor is capable of producing violent and 
dangerous symptoms. All the salts are active poisons, especially 
that known as corrosive sublimate. There are great variations in 
the grades of poisoning by mercury, and careful attention to its 
idiosyncrasies should not be overlooked. Poisoning may be divided 
into the acute and chronic varieties. 

Acute Poisoning. — This is not as common a form of poisoning 
at present as in former days, because of the intensely acrid charac- 
ter of the mercury salts. There is usually a burning, metallic taste, 
whitish precipitate on the gums, with nausea and vomiting. Shreds 
of bloody stomach mucosa are frequently stripped off. Intense 
colicky pains are developed with diarrhea, which is often bloody or 
watery, and with much tenesmus ; symptoms of collapse, such as 
cyanosis, cold skin, small, rapid pulse (150 or over), irregular rapid 
respiration. Sometimes giddiness, sometimes unconsciousness, may 
develop. Frequently there is anuria, or bloody and albumin-filled 
urine. Death occurs usually from shock, and has resulted from 
\ grain of corrosive sublimate in one to two hours. Occasionally 
death takes place after several days with the development of the 
symptoms of chronic poisoning. A form of rapid poisoning occurs 
from the inhalation of mercury containing vapors, as in mirror 
factories. Workers on hat feltings often suffer. 

Chronic Poisoning. — This may result from a single dose, but 
more often from prolonged small dosage, from the breathing of 
vapors containing mercury. The prodromal symptoms occur in 
the mouth. They are metallic taste, soreness of teeth, fetid breath, 
spongy, inflamed gums, and salivation. Discontinuance of the 
mercury and mouth hygiene usually clears up these symptoms. 
If, however, dosage is continued or rules of cleanliness neglected, 
the tongue may become swollen ; there is extreme salivation with 
marked fetor ; ulceration and bleeding may take place, and the 



ALTERATIVES. 401 

mouth gets in an abominable condition, with loose teeth or even 
jaw necrosis. Other concomitant symptoms may develop, such as 
anorexia, nausea, colic, diarrhea, constipation, sometimes a distinct 
febrile movement of the temperature (secondary infections). Ema- 
ciation, cachexia, motor weakness, restlessness, may come on. 
There is frequently a fine muscular tremor, and later paresthesias, 
anesthesias, and paralysis may develop. Skin eruptions are not 
infrequent. 

Treatment of Poisoning. — In acute poisoning from corrosive sub- 
limate or other active salt of mercury it is necessary to evacuate 
the stomach as quickly as possible and give white of eggs freely. 
The after-treatment is similar to that of other corrosive poisons — 
the use of demulcents and opiates. 

For salivation, potassium chlorate probably occupies the first 
place as a prophylactic and curative agent. It is employed as a 
gargle and mouth-wash, in a 2 to 3 per cent, solution. An astrin- 
gent wash is frequently necessary. Such drugs as tannin, myrrh, 
krameria, etc., may be used for this purpose. Where there is ex- 
tensive ulceration of the mouth, disinfectant and antiseptic solutions 
will be found desirable. 

In cases of chronic mercurial poisoning it is of primary impor- 
tance to remove all traces of the drug from the body by means 
of iodides, the dosage being limited in quantity, but continued for 
some time. A change of air, liberal and nutritious diet, and tonics 
are also necessary. 

Therapeutics. — Externally and Locally. — As a germicide, anti- 
septic, and antiparasitic the preparations of mercury are extremely 
valuable ; the corrosive chloride of mercury being extensively em- 
ployed as an antiseptic in general surgery in strengths of from 
1 : IOOO to I : 10,000. It attacks the fingers and instruments, and 
is not always a reliable germicide. 

In diseases of the skin due to animal or vegetable parasites there 
are no drugs so valuable as certain preparations of mercury, the 
ointment of ammoniated mercury being highly prized. 

Calomel in the form of an ointment, 5 to 20 grains (0.3-1.25 
Gm.) to 1 ounce (32.0 Gm.) is an efficient remedy in eczema. 

Indolent venereal ulcers are much improved by dusting them 
with calomel, while the early inflammatory conditions of these sores 
may be greatly benefited by the use of black wash. 

Many diseases of the eye, ear, nose, and throat yield to various 
preparations of mercury. The ointment of the yellow oxide of 
mercury is particularly adapted to phlyctenular ophthalmia, pannus, 
keratitis, chronic blepharitis marginalis, etc. 

Inunction with mercurial ointment or with oleate of mer- 
cury is excellent for the constitutional treatment of the first and 
second stages of syphilis. These two preparations are of great 
value in subacute synovitis, pelvic cellulitis, and syphilitic orchitis and 
epididymitis. 

The ointment of the red iodide of mercury has a reputation 

26 



402 A TEXT-BOOK OF MA TERIA MEDICA. 

as an efficient remedy in goiter and syphilitic enlargement of the 
spleen, as well as in pachymeningitis. 

The solution of nitrate of mercury is an active and reli- 
able caustic in the treatment of phagedenic ulcerations and venereal 
ulcerations of the os uteri. 

The use of mercurials is usually attended with excellent results 
in promoting resolution of fibrous induration resulting from chronic 
inflammation. 

Internally. — The principal use of mercury is undoubtedly as 
an antisyphilitic. Mercury is an antidote against constitutional 
syphilis, being particularly efficient in the secondary stage. Many 
methods of mercurializing a patient have been adopted, mention of 
which will be made under " Administration." It is perhaps un- 
necessary to caution the therapeutist to make an accurate and 
positive diagnosis of syphilis before instituting the mercurial treat- 
ment, as otherwise the consequences may be disastrous. 

Mercury has been used in all stages of the disease, though, 
possibly from ignorance of its proper use, its employment has met 
with less favorable results in the primary than in the secondary 
form, while a careful study of syphilology leads one to believe that 
in tertiary syphilis it is inferior to the iodides. Many patients, 
however, do better under mercury than they do under the iodides. 

The medical uses of mercurial preparations in disorders of the 
alimentary tract are very numerous. 

Chronic dysentery will frequently yield to yj-g- to -^ grain 

(0.OOO6-O.OOI Gm.) of CORROSIVE CHLORIDE OF MERCURY, and 

diarrheas of children — particularly those characterized by pale, 
offensive stools — together with ilco-colitis of infants, are greatly 
benefited by small doses of calomel or gray powder. 

As a purgative in bilious attacks, hepatic congestion, and cirrhosis 
calomel is an extremely valuable drug. Its action as a purgative 
will be more fully described under " Cathartics." Calomel is also a 
remarkably efficient diuretic, especially when combined with digitalis. 

Many acute febrile and inflammatory conditions, such as menin- 
gitis , pericarditis, and hepatitis, are sometimes benefited by the in- 
ternal administration of calomel, though in acute inflammations the 
chief value of the drug, whether specific or non-specific, is manifest 
in iritis and in acute bronchitis which shows a tendency to persist. 

Calomel given early in from 10- to 20-grain (0.6-1.3 Gm.) 
doses in cases of pneumonia is esteemed very highly by some 
authorities. 

Calomel and opium have been used and recommended by some 
physicians in the treatment of Asiatic cholera. 

Contraindications. — Mercury is usually contraindicated in 
tuberculosis and in persons of strumous diathesis ; and while it is 
of value when judiciously employed in chronic interstitial nephritis, 
it must nevertheless be given cautiously, and if the excretion of 
urine is diminished by its use, the drug should be immediately 
discontinued. 



AL TERA TI VES. 403 

Children, though not easily salivated, are very susceptible to 
other poisonous actions of calomel. 

Ordinarily, acute asthenic diarrhea and dysentery in adults would 
contraindicate the use of mercurials. 

Administration. — Mercury is introduced into the system by — 

1. Inunction. — The portion of the body upon which the prepa- 
ration is to be applied should first be thoroughly washed with soap 
and warm water, and the ointment well rubbed in with the palm of 
the hand. The best localities for application are the inner sides of 
the thighs, the sides of the chest, the axillae, abdomen, and back. 
An excellent way to mercurialize a child is to put the ointment on 
the abdomen, beneath a flannel binder. An efficient means also of 
favoring absorption is to apply the ointment to the soles of the 
feet, when it will be rubbed in by walking. Mercurial ointment 
is ordinarily used for this purpose, 15 to 30 grains (1.0-2.0 Gm.) 
being required for each inunction. Oleate of mercury when applied 
externally should not be rubbed in, the simple application to the 
skin being sufficient. 

2. Fumigation. — The iodide, mercuric sulphide, and calomel are 
used in this manner. The latter preparation, being preferable, is the 
one ordinarily used. From 5 to 20 grains (0.3-1.3 Gm.) of calomel 
are put in a plate or a porcelain dish over a lighted spirit-lamp. 
These are placed under a cane-bottomed chair, in which the patient 
sits, nude, enveloped in a blanket reaching to the floor and fastened 
loosely about the neck. The calomel is volatilized by the heat, 
deposited in minute particles over the surface of the body, and 
readily absorbed. The fumigation should last fifteen to twenty 
minutes. 

3. Endermically. — Mercurials may be absorbed by dusting calo- 
mel and certain other preparations on ulcers, open wounds, etc. 

4. By the Rectum. — Mercury may be administered in the form 
of a suppository containing 5 to 10 grains (0.3-0.6 Gm.) of mer- 
curial ointment. 

5. Hypodermically. — From -^ to \ grain (0.005-0.01 Gm.) of 
the bichloride of mercury, dissolved in 5 to 10 minims (0.3-0.6 
Cc.) of distilled water, is injected deeply into the muscles of the 
gluteal region or in the subcutaneous areolar tissue of the back. 
The solution of peptonate of mercury has been used for this pur- 
pose, though the preparation which is the least objectionable is the 
solution of the formamidate of mercury, 16 minims (1.0 Cc), cor- 
responding to \ grain (0.1 Gm.) of mercuric chloride. 

Numerous preparations have been recommended for hypodermic 
use. Many of them are of service, but space does not permit of 
their individual consideration. Cypridol is an excellent preparation. 

6. Internally. — In the treatment of syphilis nearly every prepara- 
tion of mercury has been employed, authorities differing in their 
choice. Bumstead prefers the bichloride, the mercurous iodide, 
and the mercurial pill; Berkeley Hill, the red mercuric iodide; 
Fox, the cyanide ; Hutchinson, the gray powder, etc. It matters 



404 A TEXT-BOOK OF MA TERIA MEDICA. 

little which of these preparations is used. That which agrees best 
with the patient is advisable. Calomel, gray powder, blue pill, and 
corrosive sublimate are ordinarily used in disorders of the ali- 
mentary tract. As a rule, the first two are preferable. 

Ferrum— Ferri— Iron. U. S. JP. 

Definition. — Metallic iron, in the form of fine, bright, and non-elastic wire. 

Preparations of Iron. 

Ferrum Reductum — Ferri Reducti — Reduced Iron (U. S. P.). (Iron by 
Hydrogen ; Quevenne's Iron.) — Origin. — Obtained by passing hydrogen through a 
hot, closed tube containing freshly prepared and thoroughly washed ferric oxide. It 
should contain not less than 90 per cent, of pure metallic iron. 

Description and Properties. — A very fine, grayish-black, lustreless powder, odorless 
and tasteless ; permanent in dry air ; insoluble in water or alcohol. 

Dose. — 1-5 grains (0.065-0.3 Gm. [i grain (0.065 Gm. ), U. S. P.]. 

Ferri Carbonas Saccharatus — Ferri Carbonatis Saccharati — Saccharated 
Ferrous Carbonate (U. S. P.). — Origin. — Prepared from ferrous sulphate, sodium 
bicarbonate, sugar, and distilled water, by solution and filtration. It should contain 
not less than 15 per cent, of ferrous carbonate. 

Description and Properties. — A greenish-brown powder gradually becoming oxidized 
by contact with air ; without odor, and having at first a sweetish, afterward a slightly 
ferruginous, taste. Only partly soluble in water, but completely soluble in hydrochloric 
acid, with copious evolution of carbonic acid gas, forming a clear, greenish-yellow 
liquid. The product should be kept in small, well-stoppered bottles. 

Dose. — 2-10 grains (0.12-0.6 Gm.) [4 grains (0.25 Gm.), U. S. P.]. 

Massa Ferri Carbonatis — Massae Ferri Carbonatis — Mass of Ferrous Car- 
bonate (U. S. P.). ( Vallet's Mass. ) — Origin. — Prepared by solution, filtration, and 
evaporation from ferrous sulphate, sodium carbonate, clarified honey, sugar, syrup, and 
distilled water. 

Description and Properties. — When recently prepared the mass is of a greenish- 
gray color, but on exposure it becomes greenish-black. 

Dose. — 3-5 grains (0.15-0.3 Gm.) [4 grains (0.25 Gm.), U. S. P.], 

Mistura Ferri Composita— Misturae Ferri Compositae — Compound Iron 
Mixture (U. S. P.). (Griffith's Mixture.) — Origin. — Prepared by mixing ferrous 
sulphate, myrrh, sugar, potassium carbonate, spirit of lavender, and rose water. 

Description and Properties. — When newly prepared it is of a dirty-greenish color, 
but slowly oxidizes on exposure to the air, and should therefore be freshly prepared 
when needed. 

Dose. — \-\\ ounces (15.0-45.0 Cc.) [4 drams (16 Cc), U. S. P.]. 

Pilulae Ferri Iodidi — Pilulas (ace.) Ferri Iodidi— Pills of Ferrous Iodide 
(U. S. P.). — Origin. — Pills made of reduced iron, iodine, glycyrrhiza, sugar, extract 
of glycyrrhiza, acacia, balsam of tolu, water, and ether, evaporated to pilular consist- 
ence. 

Description and Properties. — These preparations are very unstable, and should be 
kept from the light as much as possible. 

Dose. — One to two pills, each pill containing nearly I grain (0.065 Gm.) of ferrous 
iodide. 

Syrupus Ferri Iodidi — Syrupi Ferri Iodidi— Syrup of Ferrous Iodide (U. 
S. P.). — Origin. — A syrupy liquid containing 5 per cent, by weight of ferrous 
iodide. 

Description and Properties. — A transparent, pale-green liquid, having a sweet, 
strongly ferruginous taste and a neutral reaction. 

Dose.-- 5-30 minims (0.3-2.0 Cc.) [15 minims (1 Cc), U. S. P.]. 

Ferri Chloridum — Ferri Chloridi — Ferric Chloride. — Origin. — Prepared by 
the action of hydrochloric acid and distilled water upon iron wire, subsequent filtra- 
tion, addition of nitric acid, and crystallization. It should contain not less than 22 
per cent, of metallic iron in the form of chloride. 

Description and Properties. — Orange-yellow, crystalline pieces, odorless, or having 
a faint odor of hydrochloric acid and a strongly styptic taste ; very deliquescent in 



ALTERATIVES. 405 

moist air ; freely and completely soluble in water or alcohol, also in a mixture of 1 
part of ether and 3 parts of alcohol. Ferric chloride should be kept in glass-stoppered 
bottles, protected from light. 

Dose. — It is chiefly used topically, as an astringent and hemostatic fi grain (0.065 
Gm.), U. S. P.]. 

Liquor Ferri Chloridi — Liquoris Ferri Chloridi — Solution of Ferric Chloride 
(U. S. P.). — Origin. — An aqueous solution of ferric chloride, FeCl 3 , containing not 
less than 29 per cent, of the anhydrous salt, corresponding to 10 per cent, of metallic 
iron. 

Description and Properties. — A reddish-brown liquid, having a faint odor of hydro- 
chloric acid, an acid, strongly styptic taste, and an acid reaction. 

Dose. — 2-10 minims (0.12-0.6 Cc), largely diluted; \\\ minims (o.l Cc), 
U. o. -t»J» 

Tinctura Ferri Chloridi — Tincturae Ferri Chloridi— Tincture of Ferric 
Chloride (U. S. P.). — Origin. — A hydro-alcoholic solution of ferric chloride, con- 
taining about 13.28 per cent, of the anhydrous salt, corresponding to about 4.6 per 
cent, of metallic iron. 

Description and Properties. — A bright, brownish liquid, having a slightly ethereal 
odor, a very astringent, styptic taste, and an acid reaction. 

Dose. — 5-30 minims (0.3-2.0 Cc.) [8 minims (0.5 Cc), U. S. P.]. 

Liquor Ferri et Ammonii Acetatis — Liquoris Ferri et Ammonii Acetatis — 
Solution of Iron and Ammonium Acetate (U. S. P.) (Basham's Mixture). — 
Formula. — Prepared with tincture of ferric chloride, 40 parts ; diluted acetic acid, 
60; solution of ammonium acetate, 500; aromatic elixir, 120; glycerin, 120; water, 
to IOOO. 

Dose. — 1-4 fluidrams (4.0-15.0 Cc.) [4 fluidrams (16 Cc), U. S. P.]. 

Ferri Citras — Ferri Citratis — Ferric Citrate (U. S. P.). — Origin. — Prepared 
by evaporating solution of ferric citrate on a water-bath at a temperature not exceed- 
ing 6o° C. (140 F.). It should contain ferric citrate corresponding in amount to 
not less than 16 per cent, of metallic iron. 

Description and Properties. — Thin, transparent, garnet-red scales, without odor, 
and having a slightly ferruginous taste. Slowly but completely soluble in cold water, 
and readily soluble in hot water, but diminishing in solubility with age. Insoluble in 
alcohol. Ferric citrate should be kept in well-stoppered bottles, protected from light. 

Dose. — 5-20 grains (0.3-1.20 Gm. ), in solution. 

Vinum Ferri — Vini Ferri — Wine of Iron (U. S. P.). — Composition. — Iron and 
ammonium citrate, tincture of sweet-orange peel, syrup, and water. 

Dose.—\-\ fluidram (2.0-4.0 Cc.) [2 fluidrams (5 Cc), U. S. P.]. 

Ferri et Ammonii Citras — Ferri et Ammonii Citratis — Iron and Ammo- 
nium Citrate (U. S. P.). — Origin. — Prepared by evaporating a solution of ferric 
citrate and ammonia water. 

Description and Properties. — Thin, transparent, garnet-red scales, odorless, and 
having a saline, mildly ferruginous taste ; deliquescent in moist air. Completely sol- 
uble in water, but insoluble in alcohol. 

Dose. — 5-10 grains (0.3-0.6 Gm.) [4 grains (0.25 Gm.), U. S. P.]. 

Ferri et Quininae Citras — Ferri et Quininae Citratis — Iron and Quinine 
Citrate (U. S. P.). — Origin. — Solution of ferric citrate in distilled water and solution 
of quinine and citric acid in distilled water are mixed, evaporated on a water-bath to 
the consistence of syrup, and dried on plates of glass. 

Description and Properties. — Thin, transparent scales, of a reddish-brown color, 
without odor, and having a bitter, mildly ferruginous taste ; slowly deliquescent in 
damp air. Gradually but completely soluble in cold water, more readily soluble in 
hot water, and but partially soluble in alcohol, its solubility diminishing with age. It 
should be kept in well-stoppered bottles, protected from light. 

Dose. — 2-10 grains (0.12-0.6 Gm.) 4 grains [(0.25 Gm.) U. S. P.]. 

Elixir Ferri, Quininae et Strychninse Phosphatum— Elixiris Fern, Quininae 
et Strychninae Phosphati — Elixir of Iron, Quinine and Strychnine Phosphates. 
(U. S. P.). — Each fluidram contains I grain (0.0647 Gm.) of ferric phosphate, \ grain 
(0.0324 Gm.) of quinine, and -fa grain (0.001 Gm.) of strychnine. This is the official 
representative of a large class of popular preparations on the market. 

Ferri et Quininae Citras Solubilis — Ferri et Quininae Citratis Solubilis — 
Soluble Iron and Quinine Citrate (U. S. P.). — Origin. — Prepared in the same 
manner as the above salt, but with the addition of ammonia water. 

Description and Properties. — Thin, transparent scales, of a greenish, golden-yellow 



406 A TEXT-BOOK OF MA TERIA MEDICA. 

color, odorless, and having a bitter, mildly ferruginous taste ; deliquescent in damp 
air. Rapidly and completely soluble in cold water, but only partially soluble in alco- 
hol. It should be kept in well-stoppered bottles, protected from light. 

Dose. — 2-10 grains (0.12-0.6 Gm.) [4 grains (0.25 Gm.), U. S. P.]. 

Ferri et Strychninae Citras — Ferri et Strychninae Citratis — Iron and Strych- 
nine Citrate (U. S. P.). — Origin. — Solution of iron and ammonium citrate in distilled 
water and solution of strychnine and citric acid in distilled water are mixed, evaporated 
to the consistence of syrup by means of a water-bath, and dried on plates of glass 
[0.9-10 per cent, strychnine, 16 per cent, metallic iron equivalent]. 

Description and Properties. — Thin, transparent scales, varying in color from 
garnet-red to yellowish-brown, without odor, and having a bitter, slightly ferruginous 
taste ; deliquescent in damp air. Readily and completely soluble in water, but only 
partly soluble in alcohol. It should be kept in well-stoppered bottles, protected from 
light. 

Dose. — 1-3 grains (0.06-0.18 Gm. ) [2 grains (0.125 Gm.), U. S. P.]. 

Vinum Ferri Amarum — Vini Ferri Amari — Bitter Wine of Iron (U. S. P.). 
— Composition. — Soluble iron and quinine citrate, tincture of sweet-orange peel, syrup, 
white wine. 

Dose.— 1-2 fluidrams (4.0-8.0 Cc.) [2 fluidrams (8 Cc), U. S. P.J. 

Syrupus Ferri, Quininae et Strychninae Phosphatum — Syrupi Ferri, Quininae 
et Strychninae Phosphatum — Syrup of the Phosphates of Iron, Quinine, and 
Strychnine (U. S. P.). — Dose.— 1-2 fluidrams (4.0-8.0 Cc.) [1 fluidram (4 Cc. ), 
U. S. P.]. 

Ferri Hydroxidum — Ferri Hydroxidi — Ferric Hydroxide (U. S. P.). (Hy- 
drated Oxide of Iron, Ferri Oxidum Hydratum, U. S. P. 1890.) — Origin. — To 
38 Cc. of a solution of ammonia water in water is added a 100-Cc. solution of ferric 
sulphate in water, and the precipitate collected. 

Description and Properties. — A brownish-red magma, wholly soluble in hydro- 
chloric acid, without effervescence. 

Dose. — 4 drams (16 Gm.), or ad libitum incase of arsenical poisoning. 

Ferri Hydroxidum cum Magnesia — Ferri Hydroxidi cum Magnesia — Fer- 
ric Hydroxide with Magnesia (U. S. P.). — Solution of ferric sulphate, magnesia, 
and water. 

Dose. — Amounts as necessary ad libitum. 

Ferri et Ammonii Sulphas — Ferri et Ammonii Sulphatis — Ferric Ammo- 
nium Sulphate (U. S. P.) (Ammonio- ferric Sulphate — Ammonio-ferric 
Alum). — Origin. — The crystals formed by adding ammonium sulphate to a boiling-hot 
solution of ferric sulphate. 

Description and Properties. — Pale-violet, octahedral crystals, odorless, and having 
an acid, styptic taste ; efflorescent on exposure to the air. Soluble in 3 parts of water 
and in 0.8 part of boiling water; insoluble in alcohol. The product should be kept 
in well-stoppered bottles. 

Dose. — 5-15 grains (0.3-I.0 Gm.) \j\ grains (0.5 Gm.), U. S. P.]. 

Ferri et Ammonii Tartras — Ferri et Ammonii Tartratis — Iron and Ammo- 
nium Tartrate (U. S. P.) (Ammonio-ferric Tartrate). — Description and Prop- 
erties. — Thin, transparent scales, varying in color from garnet-red to reddish-brown, 
without odor, and having a sweetish, slightly ferruginous taste ; slightly deliquescent in 
the air. Very soluble in water; insoluble in alcohol. Iron and ammonium tartrate 
should be kept in well-stoppered bottles, protected from light. 

Dose. — 10-30 grains (0.6-2.0 Gm.) [4 grains (0.25 Gm.), U. S. P.], 

Ferri et Potassii Tartras — Ferri et Potassii Tartratis — Iron and Potassium 
Tartrate (U. S. P.) (Potassio-ferric Tartrate). — Description and Properties. — 
Thin, transparent scales, varying in color from garnet-red to reddish-brown, without 
odor, and having a sweetish, slightly ferruginous taste ; slightly deliquescent in the air. 
Very soluble in water; insoluble in alcohol. It should be kept in well-stoppered bottles, 
protected from light. 

Dose. — 5-20 grains (0.3-1.2 Gm.) [4 grains (0.25 Gm.), U. S. P.]. 

Ferri Phosphas Solubilis — Ferri Phosphatis Solubilis — Soluble Ferric 
Phosphate (U. S. P.). — Description and Properties. — Thin, bright-green, transparent 
scales, odorless, and having an acidulous, slightly saline taste. The salt is permanent 
in dry air when excluded from light, becoming dark and discolored when exposed to 
it. Freely and completely soluble in water, but insoluble in alcohol. It should be 
kept in dark amber-colored, well-stoppered bottles (12 per cent, metallic iron). 

Dose. — 5-10 grains (0.3-0.6 Gm.) [4 grains (0.25 Gm.), U. S. P.]. 



ALTERATIVES. 407 

Ferri Pyrophosphas Solubilis — Ferri Pyrophosphatis Solubilis — Soluble 
Ferric Pyrophosphate (U. S. P.). — Description and Properties. — Thin, apple-green, 
transparent scales, without odor, and having an acidulous, slightly saline taste ; perma- 
nent in dry air if protected from light, and if exposed to it becoming dark and dis- 
colored. Freely and completely soluble in water, but insoluble in alcohol. It should 
be kept in dark amber-colored, well-stoppered bottles (10 per cent, metallic iron). 

Dose. — 2-5 grains (0.1-0.3 Gm.) [4 grains (0.25 Gm.), U. S. P.]. 

Ferri Hypophosphis — Ferri Hypophosphitis — Ferric Hypophosphite 
(U. S. P.). — Origin. — The precipitate formed by mixing solutions of sodium hypo- 
phosphites and ferric chloride or ferric sulphate. 

Description and Properties. — A white or grayish-white powder, odorless and nearly 
tasteless, permanent in the air. Only slightly soluble in water. It should be kept in 
well-stoppered bottles. 

Dose. — 5-10 grains (0.3-0.6 Gm.) [3 grains (0.2 Gm.), U. S. P.]. 

Ferri Sulphas — Ferri Sulphatis — Ferrous Sulphate (U. S. P.). — Origin. — 
Obtained by the action of sulphuric acid and water upon iron wire. 

Description and Properties. — Large, pale bluish-green, monoclinic prisms, with- 
out odor, and having a saline, styptic taste; efflorescent in dry air; on exposure to 
moist air the crystals rapidly absorb oxygen, becoming coated with a brownish-yellow, 
basic ferric sulphate. Soluble in 1.8 parts of water and in 0.3 part of boiling water ; 
insoluble in alcohol. 

Dose. — 1-3 grains (0.06-0. 18 Gm. ) [3 grains (0.18 Gm.), U. S. P.]. 

Ferri Sulphas Exsiccatus — Ferri Sulphatis Exsiccati — Dried Ferrous Sul- 
phate (U. S. P.). — Description and Properties. — A grayish-white powder, slowly but 
completely soluble in water. 

Dose. — J-2 grains (0.03-0. 12 Gm.) [2 grains (0.12 Gm.), U. S. P.]. 

Ferri Sulphas Granulatus — Ferri Sulphatis Granulati — Granulated Ferrous 
Sulphate (U. S. P.). — Description and Properties. — A pale bluish-green, crystallized 
powder, which should conform in every respect to the reactions and tests given under 
Ferri Sulphas in the U. S. P. 

Dose. — £-3 grains (0.03-0.18 Gm. [3 grains (0.18 Gm.), U. S. P.]. 

Liquor Ferri Subsulphatis — Liquoris Ferri Subsulphatis — Solution of Ferric 
Subsulphate (U. S. P.) (Solution of Basic Ferric Sulphate — Monsel's 
Solution). — Origin. — An aqueous solution of basic ferric sulphate — of varying chem- 
ical composition — corresponding to about 1 3.6 per cent, of metallic iron. 

Description and Properties. — A dark, reddish-brown liquid, odorless or nearly so 
of an acid, strongly styptic taste, and an acid reaction. Miscible with water and alco- 
hol in all proportions, without decomposition. 

Dose. — 1-10 minims (0.06-0.6 Cc.) [3 minims (0.2 Cc), U. S. PJ, largely diluted 
— chiefly used, however, as a local styptic. 

Liquor Ferri Tersulphatis — Liquoris Ferri Tersulphatis — Solution of Ferric 
Sulphate (U. S. P.). — Origin. — An aqueous solution of normal ferric sulphate, con- 
taining about 36 per cent, of normal ferric sulphate, and corresponding to not less than 
10 per cent, of metallic iron. 

Description and Properties. — A dark, reddish-brown liquid, almost odorless, having 
an acid, strongly styptic taste, and an acid reaction. Miscible with water and alcohol 
in all proportions, without decomposition. 

Dose. — 1-10 minims (0.06-0.6 Cc. ), given in the same manner and for the same 
purposes as the preceding preparation. 

Pilulae Aloes et Ferri — Pilulas (ace.) Aloes et Ferri — Pills of Aloes and 
Iron (U. S. P.). — Described under Aloes. 

Dose. — 5-10 grains (0.3-0.6 Gm.), or two or three pills. 

Pilulae Ferri Carbonatis — Pilulas (ace.) Ferri Carbonatis— Pills of Ferrous 
Carbonate (U. S. P.) (Ferruginous Pills — Chalybeate Pills — Blaud's Pills). 
— Dose. — 2-5 pills, each pill containing I grain (0.064 Gm.) of ferrous carbonate. 

Allied Compounds. 

Haemogallol. — Origin. — Prepared by the action of pyrogallol on the coloring- 
matter of the blood. 

Description and Properties. — A reddish-brown, tasteless powder. 

Dose. — 1-8 grains (0.06-0.5 Gm.). 

Haemol. — Origin. — Prepared by the action of zinc dust on the coloring-matter of 
the blood. 



408 A TEXT-BOOK OF MA TERIA MEDICA. 

Description and Properties. — A blackish-brown powder having a slight taste. 

Dose. — 1-8 grains (0.06-0.5 Gm.). 

Ferratin. — Origin. — A compound of iron first obtained by Professor Schmiedeberg 
from hog's liver. 

Description and Properties. — A fine, reddish-brown powder, containing about 7 per 
cent, of iron. One variety is insoluble, though the sodium ferratin is freely soluble in 
water. 

Dose. — 10-20 grains (0.16-1.2 Gm.). 

Haemalbumin. — A preparation said to contain two albuminoids and salts of the 
blood. 

Description and Properties. — A permanent powder, soluble in water and in alcohol. 

Dose. — 5-15 grains (0.3-1.0 Gm.). 

Haemoglobin. — Said to be the coloring-principle of the solid elements of the blood. 

Dose. — 1-3 grains (0.06-0.18 Gm.). 

Haemoferrum. — Claimed to be a natural proteid compound of iron obtained from 
bullock' s blood. 

Dose. — 1-3 grains (0.06-0. 1 8 Gm.). 

Iron Quinine Chloride. — A yellowish-red powder, soluble in water, alcohol, and 
glycerin. 

Dose. — 1-3 grains (0.06-0. 18 Gm.). Used externally as a hemostatic. 

Other newer preparations of iron are Feralboid, a peptonized albuminate of iron ; 
Fercremol, a compound of hemoglobin and iron, containing 3 per cent, of iron. Dose, 
3-8 grains (0.2-0.5 Gm. ) ; Ferralbumose, prepared from fat-free meat and treated 
with artificial gastric juice ; the filtered solution is freed from albumin, filtered, neutral- 
ized, and dried in vacuo. A 10 per cent, solution of this albumose is precipitated by 
10 per cent, ferric chloride, and the precipitate is then dried and powdered. Ferri- 
pyrine, a combination with three molecules of antipyrine and one of ferric chloride, and 
said to possess the properties of both constituents. Dose, 8 grains (0.5 Gm. ) in anemic 
conditions associated with headaches and neuralgia. 

Ferrosol is a double saccharate of ferrous oxide and sodium chloride. It is not 
precipitated by the addition of acids, alkalies, or by changes in temperature. It con- 
tains 0.77 per cent, of iron. Ferrostyptin, an iron preparation containing formaldehyd 
and readily soluble in water, is used as a hemostyptic antiseptic. It is not caustic and 
is useful in the mouth and nose. Dose, 5-8 grains (0.3-0.5 Gm.). Ferrum caseina- 
tum, a preparation containing 5.2 per cent, ferric oxide, and prepared by precipitating 
a solution of lactate of iron with a solution of calcium caseinate. It is tasteless and 
odorless, and soluble in water made alkaline by sodium carbonate. Dose, $—1$ grains 
(0.3-1.0 Gm.). Fersan is one of the many new preparations of blood. It is held to 
be the phosphoric acid containing albuminoids of the blood. Sanguinal, Sanguini- 
form, and Carniferrin are other blood-preparations. Many other preparations of iron 
are daily being added to the already abundant list. 

Antagonists and Incompatibles. — The ferric salts are incom- 
patible with tannic and gallic acids and vegetable astringents, and 
gelatinize mucilage of acacia. The carbonates are also incompat- 
ible with tannic and mineral acids and acidulous salts. 

The salts of the vegetable acids and the iodides are incompatible 
with mineral acids, tannic acid, and with alkalies and their carbon- 
ates. 

Physiological Action. — Iron is an essential element of the body, 
there being 1 part of iron to 230 of red globules. In many lower 
animals iron is diffused throughout the bodily protoplasm ; in man 
it is mostly confined to one tissue, the blood. Through the iron 
compounds of the body much of the oxidizing functions of the 
various cells are carried on. 

When the body is in a normal, healthy condition, sufficient 
iron is furnished by the mixed diet to answer all physiological 
requirements. In many diseased conditions, however, there is a 



AL TERA TI VES. 409 

deficiency of iron, and it is necessary to restore this element in one 
way or another. 

Externally and Locally. — Neither the soluble ferric nor ferrous 
salts exert any action upon the unbroken skin. When applied, 
however, to mucous membranes or denuded surfaces, they are 
astringent and hemostatic, the ferric salts being the more powerful, 
coagulating albuminous fluids. The coagulum of albuminate of 
iron is usually insoluble, hence acts as a protectant and limits pene- 
tration or corrosion. The organic salts possess feeble astringent 
properties. In the iron salts the acid ion plays the more important 
role in its action on protoplasm. 

The acid and astringent preparations of iron act upon the teeth. 
The ferric oxides are disinfectant, owing to their property of con- 
verting oxygen into ozone. 

Internally. — Digestive System. — The teeth and tongue are black- 
ened by the preparations of iron. In the stomach, when not con- 
traindicated and in small doses, its slightly irritant and astringent 
properties render iron quite a valuble stomachic tonic. Under 
excessive doses or prolonged administration the acid preparations 
especially are apt to cause gastric derangement — anorexia, nausea, 
and serious indigestion. The ferric chloride is particularly valu- 
able in that its ingestion does not, like that of other preparations of 
iron, diminish the supply of hydrochloric acid in the gastric juice. 

All the preparations of iron are probably converted into the 
chloride in the stomach. When entering the intestines they are 
converted into the ferric oxide, ferrous chloride, the alkaline albu- 
minate, and the insoluble sulphide and tannate. Most of the iron 
preparations are constipating, the phosphate and pyrophosphate 
being exceptions. They tend to diminish the bile and the secre- 
tions from the gastro-intestinal tract. Constipation with dark stools 
is a frequent result of iron medication. 

Nervous System. — The general effect is tonic. In patients in- 
clined to plethora, however, certain untoward symptoms may result 
from prolonged administration, including a feeling of congestion 
in the cerebrum. 

Circulatory System. — The action of iron upon the blood is of 
great importance, since, the metal being a normal constituent of 
that fluid, its administration has a nutrient as well as a medicinal 
influence. A primary effect is to supply a deficiency of red cor- 
puscles and bring the hemoglobin up to the normal standard. It 
also increases the number of leucocytes. Iron enables the red 
corpuscles to convey more oxygen to the tissues, thus increasing 
metabolic activity in general. Long-continued dosage has been 
thought to develop a sense of fulness in the blood-vessels, dryness 
of, and a tendency to hemorrhage from, mucous membranes. 

Respiratory System. — No immediate action is perceptible under 
normal conditions, but in anemic states, by supplying the nerve- 
centers, muscles, and lungs with better blood, the respiratory power 
is increased. 



4IO A TEXT-BOOK OF MA TERIA MEDICA. 

Absorption and Elimination. — Opinions differ regarding the form 
in which iron is absorbed. Probably much of it is converted into 
the soluble chloride and absorbed as such in the stomach — while 
a portion, passing into the intestines, may there be converted into 
the soluble alkaline albuminate capable of absorption. The larger 
portion of iron taken into the system, however, is changed into the 
insoluble sulphide and tannate, and excreted as such, giving to the 
feces a black color. Such part of the iron as enters the circulation 
combines with the red corpuscles. The salts of the organic acids 
are absorbed directly into the blood. 

Such careful pharmacologists as Bunge, Schmiedeberg, and 
Hamburger claimed that inorganic preparations of iron are neither 
absorbed nor assimilated, maintaining that the blood and hemo- 
globin are influenced only by the organic compounds. Yet, not- 
withstanding these statements, clinical experience has fully demon- 
strated the value of such preparations as reduced iron, tincture of 
the chloride, carbonate, etc. ; and it is still perhaps a mooted ques- 
tion whether appreciable amounts of them are actually absorbed, 
or whether, according to Bunge, the inorganic prevent the decom- 
position of the organic salts of iron in the food by fixing the decom- 
posing agents in the intestines. At all events, the beneficial results 
in anemia and chlorosis of large doses of the inorganic prepara- 
tions are too manifest to justify abandonment of these agents 
because of our ignorance touching their modus operandi. 

At the present time it is fairly well conceded that Bunge was 
wrong in his general hypothesis, and the recent work of many 
pharmacologists has shown that most of the ordinary prepara- 
tions are capable of absorption in the intestine, and it is also 
probable that iron takes part in a number of synthetic combina- 
tions in the liver, some of which may be ultilized in normal met- 
abolism, while others are cast off in the bile and thus re-enter the 
intestinal canal. 

The amount of urea is increased and micturition rendered more 
frequent by preparations of this metal. 

Elimination takes place chiefly by the feces, to which a blackish 
color is imparted by the formation of ferrous sulphide. The bile, 
urine, and even the skin, as well as the mucous and serous mem- 
branes, share in the excretory process. 

Untoward Action. — The continued use of ferruginous prepara- 
tions has a tendency to impair the normal digestive powers, occa- 
sioning even gastric oppression, nausea, and vomiting. Reduced 
iron, the phosphate, and the pyrophosphate produce less untoward 
action than other preparations, and the ferrous are better tolerated 
than the ferric salts. Not infrequently acne of the face, breast, 
and back is occasioned, while the prolonged administration of the 
drug may in rare cases be accompanied by hemorrhages from the 
mucous membranes and symptoms of plethora and vascular ex- 
citement. Large doses of the ferrous sulphate may occasion 
obstruction of the bowels. In some rare instances irritation of the 



ALTERATIVES. 41 1 

kidneys may be induced, and again iron is often badly tolerated in 
gouty conditions. 

Poisoning. — The ferric preparations in a concentrated form pro- 
duce all the symptoms of an irritant poison — gastric pain, vomit- 
ing, etc. 

Treatment of Poisoning. — The stomach should be emptied by 
an emetic or carefully cleansed, the treatment being followed by 
the administration of alkali solutions, tannic acid, and demulcent 
drinks, the procedure being similar to that employed in poisoning 
from mineral acids. 

Therapeutics. — Externally and Locally. — The astringent and 
styptic properties of chlorides and sulphates of iron have rendered 
them serviceable in controlling hemorrhage and as local astringents 
in relaxed conditions of the pharynx and larynx and mucous mem- 
branes generally. The tincture of the chloride has been highly 
recommended as a local application to the throat in diphtheria, and 
chronic and indolent ulcers may often be benefited by a wash con- 
taining from 2 to 5 grains (0.12-0.3 Gm.) of the sulphate to I 
ounce (30.0 Cc.) of water. In subacute pharyngitis and in tonsillitis 
tincture of the chloride with glycerine, simple syrup, and chlorate 
of potash makes an effective mixture. 

It is important to remember that it is bad surgery to use 
the astringent salts of iron in deep wounds or even in superficial 
ones. Pressure will usually fulfil all the indications of an astrin- 
gent. 

Iron baths are probably of little service. 

Internally. — The most important use of iron is to restore the 
number of red corpuscles and the amount of hemoglobin. In both 
the primary and secondary anemias iron is useful. In chlorosis, 
especially, it is of great value ; but in order that its effects may be 
most beneficial, cathartics, such as rhubarb and aloes, which do not 
irritate the intestines, should accompany its use. In the many 
types of secondary anemia iron is of paramount value. It is used 
therefore following hemorrhage, acute infections as, erysipelas, scarlet 
fever, puerperal fever, diphtheria, measles, influenza, typhoid, tuber- 
culosis, syphilis, etc. 

In many constitutional disturbances associated with malnutrition 
iron is of service. Thus in the neuralgias, particularly if secondary 
anemia is a concomitant cause, in menstrual disorders, in neuras- 
thenia, in the anemia of the opium or cocaine habitue ; in the ane- 
mias due to chronic toxemia of Bright s disease it is invaluable ; 
particularly as Basham's mixture. 

Contraindications. — Iron is contraindicated practically only in 
conditions of stomach irritability, as is seen in febrile disturbances 
and in chronic disorders of that viscus. 

Administration. — If the appetite be poor, iron should be ad- 
ministered in small doses (invariably after meals) or preceded by 
vegetable bitters. The tincture of the chloride and the stronger 
preparations should be freely diluted with water. The citrate of 



412 A TEXT-BOOK OF MATERIA MEDICA. 

iron is a mild preparation well adapted for children and persons of 
delicate stomach. 

Probably the salt richest in iron, yet of all the ferruginous 
preparations the most agreeable and least irritating, is the iron and 
potassium tartrate. The soluble ferric pyrophosphate is also a 
mild and pleasant preparation. The compound iron mixture pos- 
sesses special advantages in the treatment of chlorosis and chronic 
diseases of the skin, while the solution of iron and ammonium 
acetate (Basham's mixture) is the best preparation in albuminuria — 
particularly that accompanying tubular nephritis — it being agree- 
able and well tolerated. 

The best styptic is the ferric subsulphate or its solution. 

Dialyzed iron, being agreeable to the taste, was formerly a 
popular remedy. 

Although it has been shown that Bunge's theory of the ina- 
bility of the body to utilize inorganic salts of iron is untrue, yet 
many of the newer proteid combinations serve very acceptably in 
modern therapeutics, especially in those rare cases in which marked 
idiosyncrasies to the effects of iron exist. Apart from such, how- 
ever, there is, we believe, little justification, from an economic point 
at least, in the use of the numerous patented alcoholic combina- 
tions of iron salts. 

MANGANESE. 

This metal is a normal constituent of the body, existing in ap- 
preciable, though minute, quantities in the blood, bile, etc. From 
the fact of its presence in the blood, and because of the similarity 
of its chemical affinities to those of iron, many observers have 
advocated its use as a worthy and efficient substitute for the latter 
agent. 

Its therapeutic uses as a restorative, or as an alternative or 
synergist to iron, are based more upon abstract deductions than 
upon clinical observation. Still, as its chemical character resem- 
bles that of iron — though the metal in its operation is often antag- 
onistic to the latter — its salts are of sufficient therapeutic importance 
to merit brief mention here. 

Mangani Dioxidum Precipitatum— Mangani Dioxidi 
Precipitatae— Precipitated Manganese Dioxide. 
U. 8. JP. 

Definition. — Chiefly manganese dioxide with small amounts of other oxides of 
manganese, corresponding to not less than 80 per cent, of manganese dioxide. 

Origin. — Manganese sulphate, 50; ammonia water, 250 ; solution of hydrogen 
dioxide, 250; water q. s. 

Description and Properties. — A heavy, very fine black powder, without 
odor or taste ; permanent in the air; insoluble in water or alcohol. 

Dose. — 5-40 grains (0.3-2.60 Gm.) [4 grains (0.25 Gm.), U. S. P.]. 



ALTERATIVES. 413 

Mangrani Hypophosphis— Mangani Hypophosphis 
—Manganese Hypophosphite. U. S. P. 

Definition. — It should contain not less than 97 per cent, of pure manganese 
hypophosphite (Mn(PH 2 2 ) 2 + H ? 0. 

Dose. — Average dose: 3 grains (0.2 Gm. = 200 milligrammes), (U. S. P.). It 
is contained in syrupus hypophosphitum compositus. 

Mangani Sulphas— Mangani Sulphatis— Man- 
ganese Sulphate. U. S. P. 

Origin. — Obtained by heating manganese dioxide with sufficiently strong sul- 
phuric acid, evaporation, and crystallization. 

Description and Properties. — Colorless or pale rose-colored, transparent, 
tetragonal prisms, odorless, and having a slightly bitter and astringent taste ; slightly 
efflorescent in dry air. Soluble in 0.7 part of water and in 0.53 part of boiling water ; 
insoluble in alcohol. Manganese sulphate should be kept in well-stoppered bottles. 

Dose. — 2-5 grains (o. 1-0.3 Gm.) [4 grains (0.25 Gm.), U. S. P.]. 

(For Potassium Permanganate see section on Antiseptics.) 

Antagonists and Incompatibles. — The salts of lead, silver, and 
mercury are incompatible with manganese. 

Synergists. — Iron is theoretically synergistic, and the salts of 
zinc, copper, and silver are similar in their action on the nervous 
system. 

Physiological Action. — Externally and Locally. — The two salts 
above mentioned have no important local action. 

Internally. — In large doses these salts, especially the sulphate, 
irritate the gastro-intestinal tract, while excessive doses may even 
occasion gastro-enteritis. The sulphate acts as an emeto-cathartic 
and possesses cholagogue properties. 

As is the case with many other drugs of this character, small 
doses may even promote the appetite and improve the digestive 
function. Manganese dioxide is held by many observers to play 
some role as a tissue oxidizer ; serving in this function a purpose 
similar to that of iron. It has been suggested that manganese has 
a certain catalytic power in the bodily cells. Large doses, or the 
continued administration of these preparations, affect the system 
more like zinc than iron, producing great depression, muscular 
weakness and waste, diminishing the pulse-beat, weakening the 
heart, and lowering arterial tension. There is, moreover, a tend- 
ency to fatty degeneration of the muscles and liver. 

Therapeutics. — The manganese dioxide is highly beneficial in 
amenorrhea and dysmenorrhea, and has been used in the treatment 
of gastralgia, pyrosis, and simple ulcer of the stomach. Its action 
probably resembles that of bismuth, though it is a much less 
efficient remedy than the latter drug. 

It is of interest to note that many practitioners say that they 
derive no benefit from the use of manganese salts alone in the 
treatment of amenorrhea. 

The sulphate is used occasionally as a cholagogue purgative in 
malarial jaundice, although why it should be preferred to many 



414 A TEXT-BOOK OF MATERIA MEDICA. 

other and superior cholagogues it is difficult to understand. Gouty 
dyspepsia appears to have been much improved by the use of 
manganese. The association of iron and manganese makes a 
valuable combination in the treatment of chlorosis and many- 
variations of secondary anemia. 

HEAVY METALS USED FOR LOCAL PURPOSES. 

A large number of the heavy metals, while they have a pro- 
found influence on the nutritive processes, are not known to possess 
any beneficial actions, but rather so depress metabolism as to be 
more harmful than useful. They are employed, however, very 
widely for their local astringent and antiseptic effects, and will be 
considered in this place as belonging to the other heavy metals, 
yet distinct from them. 

They are silver, copper, lead, zinc, aluminum, cerium, and bis- 
muth. In many former editions of this book they have been 
classed as astringents. 

The astringent and escharotic action of all of the metals is 
prominent. Such actions depend, however, in the dissociable salts 
upon both ions of the compound, the acid as well as the metal. 
From the standpoint of the metal they vary in strength of action 
widely, thus the series, from strongest to weakest is : mercury, tin, 
silver, copper, zinc, iron, aluminum, and lead. For the acid ion, 
from most to least active, hydrochloric, nitric, sulphuric, oxalic, 
tartaric, citric, acetic acids. Thus, a combination of an active metal- 
lic ion, such as Hg, with an active acid, CI, produces the very corro- 
sive HgCl 2 , corrosive sublimate, while lead acetate, the combination 
of the two mildest metal and acid ions respectively, produces a 
mild astringent salt. 

By a proper regulation, therefore, of acid and metal, almost any 
grade of action may be brought about. Thus, for definite dilutions 
and concentrations those 

(i) Compounds that are mainly astringent are: alum, lead 
acetate, zinc oxide, bismuth subnitrate, etc. 

(2) Compounds that are astringent and caustic are : iron salts, 
zinc sulphate, zinc acetate, copper acetate, silver nitrate, lead nitrate, 
etc. 

(3) Compounds which are mainly corrosive and caustic are : all 
mercury salts, zinc chloride, tin chloride, antimony chloride, copper 
sulphate, etc. 

Inasmuch as many of these metals when taken for some time 
cause symptoms of chronic poisoning, they are here considered in 
greater detail. 

Plumbum— Plumbi— Lead. 

The salts of lead only are used in medicine, the official salts being as follows : 
Plumbi Acetas — Plumbi Acetatis — Lead Acetate (U. S. P.) (Sugar of 
LEAD). — Origin. — Metallic lead is dissolved in the presence of air, in acetic acid, or 



HEA VY METALS USED FOR LOCAL PURPOSES. 415 

lead oxide is dissolved by the aid of a gentle heat in acetic acid and water, the solu- 
tion being filtered, evaporated, and crystallized. 

Description and Properties. — Colorless, shining, transparent, monoclinic prisms or 
plates, or heavy, white, crystalline masses, or granular crystals, having a faintly 
acetous odor and a sweetish, astringent, and afterward metallic taste. On exposure to 
the air, efflorescent and absorbing carbon dioxide. Soluble in 2 parts of water and in 
30 parts of alcohol, in 0.5 part of boiling water, and in I part of boiling alcohol. Lead 
acetate should be kept in well-stoppered botdes. 

Dose. — £-5 grains (0.03-0,3 Gm.) [1 grain (0.065 Gm.), U. S. P.]. 

Liquor Plumbi Subacetatis — Liquoris Plumbi Subacetatis— Solution of 
Lead Subacetate (Goulard's Extract). Used externally and locally. (The solu- 
tion contains not less than 25 per cent, of lead subacetate.) 

Liquor Plumbi Subacetatis Dilutus — Liquoris Plumbi Subacetatis Diluti — 
Diluted Solution of Lead Subacetate (Lead Water). — Used externally and 
locally. (It contains I per cent, of lead subacetate.) 

Ceratum Plumbi Subacetatis — Cerati Plumbi Subacetatis — Cerate of Lead 
Subacetate (Goulard's Cerate).— Used externally and locally. (Goulard" s extract, 
20; camphor, 2; wool-fat, 20; paraffin, 20; white petrolatum, 38. ) 

Plumbi Iodidum— Plumbi Iodidi— Lead Iodide (U. S. P.)-— Origin.— Obtained 
by mixing a solution of lead nitrate and potassium iodide, and drying the precipitate. 

Description and Properties. — A heavy, bright-yellow powder without odor or taste. 
Permanent in the air. Soluble in about 1300 parts of water and in about 200 parts of 
boiling water, separating from the latter solution in brilliant golden-yellow spangles or 
crystalline laminae. Very slightly soluble in alcohol, but soluble, without color, in 
solutions of the fixed alkalies, in concentrated solutions of the acetates, of the alkalies, 
potassium iodide, and sodium hyposulphite, and in a hot solution of ammonium 
chloride. Lead iodide should be kept in well-stoppered bottles. 

Dose. — \ grain (0.013 Gm.). 

Plumbi Nitras— Plumbi Nitratis— Lead Nitrate (U. S. P.).— Origin.— Pre- 
pared by dissolving lead in diluted nitric acid. 

Description and Properties. — Colorless, transparent, octahedral crystals, or white, 
nearly opaque crystals, without odor and having a sweetish, astringent, and afterward 
metallic taste. Permanent in the air. Soluble in 1. 85 parts of water; almost in- 
soluble in alcohol. Used externally and locally. 

Plumbi Oxidum — Plumbi Oxidi — Lead Oxide (U. S. P.) (Litharge).— 
Origin. — Obtained by roasting lead in air. 

Description and Propei'ties. — A heavy, yellowish or reddish-yellow powder or 
minute scales, without odor or taste. On exposure to air it slowly absorbs moisture 
and carbon dioxide. Almost insoluble in water and insoluble in alcohol. Soluble in 
acetic or diluted nitric acid and in warm solutions of the fixed alkalies. Lead oxide 
should be kept in well-closed vessels. Used externally and locally. 

Emplastrum Plumbi— Emplastra Plumbi — Lead Plaster (Diachylon Plas- 
ter). Used externally and locally. 

(Lead oxide or lead plaster is contained in emplastrum ammoniaci cum hydraigyro 
and emplastra ferri, hydrargyri, opii, resinse, and saponis.) 

Unguentum Diachylon — Unguenti Diachylon — Diachylon Ointment. — 
(Lead plaster, 50 ; olive oil, 49; oil of lavender flowers, I.) Used externally and 
locally. 

Physiological Action. — Lead per se is practically inert ; some 
of its salts, however, particularly the acetate, possess valuable 
therapeutic properties. 

Externally and Locally. — Applied to the unbroken skin, solu- 
tions of lead salts have little, if any, effect, yet they act readily upon 
denuded surfaces, blanching the tissue of the parts by contraction 
of the small blood-vessels. They coagulate the albumin of the 
protoplasm of the neighboring superficial cells, and the coagulum 
being insoluble in an excess of the lead salt thus forms a protective 
coating for the healthier structure beneath. 

These salts have likewise a sedative action because of the 



41 6 A TEXT- BOOK OF MATERIA MEDIC A. 

decreased local circulation. The nitrate alone is irritating because 
of the nitric acid ion.- # 

Internally. — Digestive System. — Lead acts immediately in the 
mouth, causing a sweet, styptic taste and coagulating the mucus. 
It contracts the cells and vessels of the entire alimentary canal, 
inducing dryness by diminished secretion. Consequent to the dis- 
turbed physiological functions of the digestive tract, the peristaltic 
movements diminish, and constipation necessarily ensues. 

In small amounts lead salts have practically no action on the 
various cerebral or medullary functions. In chronic poisoning 
these are markedly affected. 

Absorption and Elimination. — The preparations of lead are con- 
verted in the stomach into albuminates ; and thence taken up by 
the blood, very little absorption taking place in the intestine, where 
the lead is converted into an insoluble sulphide. It is absorbed by 
the abraded skin, and enters directly into combination with the 
albumin of the tissues. A portion of the lead albuminate is elimi- 
nated by the liver with the bile into the intestine, where, being con- 
verted into a sulphide, it is excreted in that form with the feces. 
The skin, kidneys, and mammary glands assist in its elimination. 

Excretion is very slow, the liver and kidneys retaining lead for a 
long time. 

Uterus. — Under the influence of lead, abortion is liable to 
occur or the child be still-born. 

Untoward Action. — Undesirable results have followed the ad- 
ministration of medicinal doses of lead acetate, evidently arising 
from insufficient elimination. Baker observed loss of appetite, gas- 
tralgia, constipation, and paralysis of three weeks' duration. This 
last symptom occurred in the hand of a man who had taken I grain 
(0.06 Gm.) of lead acetate twice daily for four days to relieve hem- 
aturia. In another case attacks of colic, lasting several months, 
followed the exhibition of 4 grains (0.25 Gm.) of the same salt for 
three days. Tanquere des Planches suggests caution in too free 
an administration of lead preparations, as being prone to occasion 
disagreeable symptoms. Hair dyes should be remembered in this 
connection. 

The external application of lead solutions and ointments some- 
times produces unpleasant effects, such as discoloration of the skin. 
In the mucous membrane lead rarely excites symptoms of poison- 
ing, a single case being reported where lead water compresses 
were applied to the eye. Gastric pains have occurred after re- 
peated applications of such compresses to a contused shoulder, the 
pains ceasing with their withdrawal and reappearing with a renewal 
of the treatment. Colic and paralysis of the member have fol- 
lowed washing of a large ulcer of the leg with lead water, these 
symptoms disappearing upon a withdrawal of the drug. In still 
another case a sweetish, styptic taste in the mouth and stiffness of 
the neck resulted from the external use of the solution. 

Poisoning. — Acute poisoning from therapeutic doses is, for- 



HEA VY METALS USED FOR LOCAL PURPOSES. 417 

tunately, rare, the acetate — the form generally given — producing 
emesis, thus preventing toxic effects of the drug. 

The first symptom of poisoning is a sweetish, metallic taste, 
soon followed by nausea and vomiting of a white, milky fluid con- 
taining curdy material — the result of a combination of the excess 
of lead with the hydrochloric acid of the gastric juice, and the 
formation of lead chloride. Constipation and subsequent diarrhea 
usually occur, with black passages, the discoloration being caused 
by the sulphide of lead formed in the intestinal canal. There is 
severe, persistent pain in the abdominal muscles, which are rigid 
and contracted, while a retraction of the abdominal walls is clearly 
perceptible. There are great thirst, and possibly cramps in the 
calves of the legs, neuralgic pains, muscular twitchings, vertigo, 
stupor, anesthesia, and paralysis. Tenesmus is present, and the 
face is pale and the lips vivid. As a rule, the liver is retracted and 
often diminished in size. The pulse is rapid and tense at first, 
becoming weak, compressible, and slow. 2 ounces (60.0 Gm.) of 
the acetate have caused death in three days. 

Treatment of Poisoning. — Evacuation of the stomach is impera- 
tive, the process being more or less assisted by the emetic property 
of the drug. Some sulphate should be administered in order to 
form an insoluble lead compound. Epsom and Glauber's salts are 
the best antidotes, since they are readily soluble and easily ob- 
tained; acting, moreover, as purges, they empty the intestinal 
canal. Opium will serve to relieve pain and irritation, while to 
maintain bodily temperature hot applications can be used on the 
feet and abdomen. 

CJironic Poisoning. — Chronic plumbism arises from a number 
of causes. The train of untoward symptoms is occasioned by long- 
continued medicinal use of lead preparations. Very frequent sources 
of poisoning are : drinking water conveyed in lead pipes, and foods 
colored with chrome yellow and those contained in cans soldered 
with lead. It is especially liable to occur among painters (colica 
pictonum), manufacturers of lead salts, color-grinders, and type- 
setters and founders. Hair dyes and cosmetics frequently cause 
lead-poisoning. Other sources are articles wrapped in tinfoil, 
cheap camp outfits, forks, plates and spoons, some glazed earthen- 
wares. 

The symptoms develop with comparative uniformity, affecting 
chiefly the (1) intestines, (2) blood, (3) kidneys, and (4) nervous 
system. (1) The intestinal symptoms are those of local irritation, 
anorexia, constipation, dark feces, occasional diarrheal attacks, 
mouth tastes bad, smells badly, dark discoloration about the teeth 
(so-called lead line), particularly in those who do not keep the 
mouth clean. Colic usually develops after a short time — it often 
precedes a diarrheal attack. The intestinal spasms are exceedingly 
severe and come on with great suddenness. 

(2) From the beginning there is an increasing grade of anemia. 
The red blood-cells degenerate, are pigmented, and the blood- 

27 



418 A TEXT-BOOK OF MATERIA MEDICA. 

making organs are also involved. The leucocytes may be increased 
or diminished. Pallor may become extreme. 

(3) The kidneys almost invariably show granular degenerative 
changes. The urine is usually increased in amount, is of low spe- 
cific gravity, usually contains albumin, granular and hyaline casts. 
The nephritis, originally parenchymatous in type, may become 
diffuse. 

(4) The nervous symptoms are very variable. There is usually 
very early with the anemia and nephritis a persistent headache. 
The peripheral motor nerves are also affected and a multiple neu- 
ritis develops with extensive extensor paralysis. There is drop- 
wrist, drop-toe, etc. Usually bilateral, it may be unilateral. Pro- 
nation of the hand is possible, as the supinator longus is usually 
not involved in the paralysis. Sensory involvement is also possible. 
Anesthesias, paresthesias, sometimes neuralgic pains, occur. Arthral- 
gias (gout-like) are not uncommon results of interference with the 
functions of the trophic nerves. Occasionally the nervous struct- 
ures of the retina (amblyopia) are involved, either as a result of 
the albuminuria or as a direct poisoning by the lead. The brain 
itself may become affected. Acute delirious states may be induced, 
or there may be hallucinations with mental confusion and dementia 
and convulsive seizures of an epileptiform nature. 

Treatment of Poisoning. — Removal of the poison is the first in- 
dication. The sulphates are given for their chemical and purgative 
effects, yet in chronic plumbism the hepatic purgatives — calomel, 
gamboge, jalap, etc. — are often preferable. Opium and morphine 
relieve pain and spasms, being claimed by some authorities as spe- 
cifics in lead-poisoning. Sulphuric acid lemonade and plenty of 
milk have been found beneficial. Potassium iodide in 10-grain 
doses, three times daily, has an eliminative effect. Lead may be 
detected in the urine after giving iodides. This test should always 
be applied in suspected cases. The cerebral symptoms may be 
alleviated by a diaphoretic, such as pilocarpin or an alcohol 
sweat. 

In progressive paralysis, strychnine is widely employed. Fara- 
dization of the muscles, if they respond, or otherwise galvanization, 
should be used to increase muscular force and prevent atrophy. 

Therapeutics. — Externally and Locally. — Acetate being the typi- 
cal lead salt, its action will be first considered. It acts as a seda- 
tive as well as an astringent in acute inflammations, such as eczema 
(not chronic), impetigo, lichen, and erythema ; but it must not be 
used stronger than 10 grains (0.64 Gm.) to 1 ounce (30.0 Cc.) of 
water. 

It is of service as an injection in gonorrhea, lencorrhca, gleet, 
and otorrhea. In combination with opium it makes a good topical 
application for hemorrhoids. As a gargle it is of some value, and 
is also serviceable in orchitis, synovitis, and paronychia. 

Internally. — Its most important use is in checking hemorrhages^ 
in which use it is associated with opium, although it is chemically 



HE A VY METALS USED FOR LOCAL PURPOSES. 419 

incompatible with that drug. It is of service in hemorrhage in 
typhoid fever, yellow fever ; hemoptysis, and gastric ulcer. 

Morbid discharges, such as the night-sweats and diarrhea of phthi- 
sis and the diarrhea of typhoid, dysentery, cholera infantum, secretions 
in bronchorrhea, and serous diarrhea, are effectually checked by the 
acetate of lead and opium, which diminishes the pain, griping, and 
tenesmus attending the respective affections. By far its most fre- 
quent use, however, is in serous diarrheas, the drug acting very 
quickly and efficiently, and being both sedative and astringent. 

Given in chronic gastritis with pain, lead acetate affords marked 
relief. 

Liquor Plumbi Subacetatis. — This preparation is used exten- 
sively for bruises, sprains, acute eczema, and as an application in 
ecthyma, erysipelas, and all kinds of inflammations ; it should be 
well diluted. It also relieves the itching of urticaria, pruritus pu- 
dendi, and eczema. 

A felon may sometimes be aborted, particularly if not deep, by 
saturating bread-crumbs with Goulard's solution, making a poul- 
tice, and placing it over the finger. 

Plumbi Iodide. — Used very little. It acts beneficially when 
employed as an ointment applied to enlaiged lymphatic glands and 
spleen ; also for psoriasis and chronic eczema. 

Plumbi Oxidum. — Hebryre commends an application of equal 
parts of lead plaster and linseed oil for sweating of the feet. It is 
chiefly used in the preparation of diachylon or lead plaster, emplas- 
trum saponis and emplastrum resinae being also prepared with the 
oxide. 

Plumbi Nitras. — Used with good results in onychia and also 
in the manufacture of Ledoyne's disinfectant. It is an excellent 
remedy for fissured nipples, care being taken to wash the nipple 
before suckling. It destroys the fetid odor arising from gangrenous 
sores and offettsive discharges from the ears, nostrils, rectum, and 
vagina. 

Administration. — Locally a watery solution of lead acetate, 10 
grains (0.64 Gm.) to 1 ounce (30.0 Cc), is used. Powdered opium 
can be added, 1 dram to the pint of water. Applied to mucous 
membranes or used as an injection, 2 grains (0.12 Gm.) to 1 ounce 
(30.0 Cc.) of water, or 5 grains (0.32 Gm.) of the acetate and 5 grains 
(0.32 Gm.) of zinc sulphate in 1 ounce (30.0 Cc.) of water — rose water, 
for instance — proves a most efficient application. Suppositories for 
hemorrhoids may contain 1 grain (0.06 Gm.) of opium to 3-5 grains 
(0.19-0.32 Gm.) of the acetate. The pilulae plumbi cum opio — lead 
acetate 3 grains (0.19 Gm.), opium 1 grain (0.06 Gm.) — is mostly 
used internally, one pill being taken every three hours. In dysen- 
tery and cholera infantum an enema containing 5 grains (0.32 Gm.) 
of lead acetate to 1 grain (0.06 Gm.) of opium, or J grain (0.03 
Gm.) of morphine to 1 ounce (30.0 Cc.) of water, gives excellent 
results. 

Should there be any abrasion of the skin, lead subacetate must 



420 A TEXT-BOOK OF MA TERIA MEDICA. 

not be used, as it prevents healing by constringing the edges of 
the wound. 

Solution of subacetate of lead is most frequently used in union 
with opium, forming the well-known L. and L., or lead-water-and- 
laudanum, solution. It is also used in conjunction with glycerin, 
i ounce of each, or as Goulard's cerate, consisting of 20 parts 
Goulard's extract to 80 parts camphor cerate. 

For ulcers, fissured nipples, and epithelioma lead nitrate is used, 
chiefly in the powdered form. In the nose, ears, vagina, and rectum 
a douche (2-5 grains (0.12-0.32 Gm.) to 1 ounce (30.0 Cc.) of water) 
is used. A solution of 10 grains (0.64 Gm.) to 1 ounce (30.0 Cc.) 
of glycerin or brandy is a very good application for sore nipples. 

Zincum— Zinci— Zinc. U. S. JP. 

Origin. — Obtained by roasting the native zinc sulphide or carbonate, and reducing 
the resulting oxide with charcoal. 

Description and Properties. — A bluish-white metal, showing a crystalline 
fracture and having a specific gravity ranging from 6.9 when it is cast to 7.2 after it is 
rolled. Soluble in diluted sulphuric or hydrochloric acid, with evolution of hydrogen gas. 

Metallic zinc occurs in the form of thin sheets or in irregular, granulated pieces, or 
moulded into thin pencils, or in a state of fine powder. 

Official Salts. 

Zinci Acetas — Zinci Acetatis — Zinc Acetate. — Origin. — Obtained by dissolv- 
ing zinc acetate in acetic acid and water and boiling : zinc acetate crystallizes out. 

Description and Properties. — Soft, white, six-sided, monoclinic plates, of a pearly 
luster, having a faintly acetous odor and an astringent, metallic taste. Exposed to the 
air, the salt gradually effloresces and loses some of its acid. Soluble in 2.5 parts of 
water and 36 parts of alcohol. Zinc acetate should be kept in well-stoppered bottles. 

Dose. — As a tonic, 3—2 grains (0.03-0. 12 Gm.); as an emetic, 10-30 grains 
(0.6-2.0 Gm.) ; but principally used externally and locally [2 grains (o. 12 Gm. ),U. S. P. 

Zinci Carbonas Praecipitatus — Zinci Carbonatis Praecipitati — Precipitated 
Zinc Carbonate. — Origin. — Prepared by pouring together solutions of zinc sulphate 
and sodium carbonate, and drying the precipitated zinc salt. 

Description and Properties. — An impalpable white powder, of somewhat variable 
chemical composition, without odor or taste ; permanent in the air. Insoluble in water 
or alcohol. 

Dose. — 2-3 grains (0.12-0.18 Gm.). Chiefly used externally. 

Zinci Chloridum— Zinci Chloridi— Zinc Chloride (U.S. P.). 

A white, granular powder or porcelain-like masses. Very deliquescent. Not used 
internally. 

Zinci Iodidum —Zinci Iodidi— Zinc Iodide. — Origin. — Prepared by dissolving 
zinc oxide or carbonate in hydriodic acid. 

Description and Properties. — A white, granular powder, odorless, having a sharp, 
saline, and metallic taste. Very deliquescent and liable to absorb oxygen from the air, 
becoming brown from liberated iodine. Readily soluble in water, alcohol, or ether. 
Zinc iodide should be kept in small glass-stoppered bottles. 

Dose. — \-2 grains (0.03-0. 12 Gm.). Also used externally. [1 grain (0.065 Gm.), 
U. S. P.]. 

Zinci Oxidum — Zinci Oxidi — Zinc Oxide. — Origin. — Prepared by heating zinc 
carbonate to redness in a crucible. 

Description and Properties. — An amorphous white powder without odor or taste. 
Insoluble in water or alcohol. It should be kept in well -stoppered bottles. 

Dose. — }- 5 grains (0.015-0.3 Gm.). 

Zinci Phenolsulphonas — Zinci Phenolsulphonatis— Zinc Phenolsulpho- 
nate. — Zn(C G H 4 (OH)S0 3 ) 2 - ! - 811./), commonly known as zinc sulphocarbolate. It 
should contain not less than 99.5 per cent, zinc paraphenolsulphonate. (C 6 H 4 (OH)- 
SO,) 2 Zn 1 :4+8H,0. 



HE A VY METALS USED FOR LOCAL PURPOSES. 421 

Description and Properties. — Colorless, transparent, rhombic prisms, or tabular 
crystals, odorless, and having an astringent, metallic taste ; effloresces on exposure and 
may become pink. Easily soluble in water or alcohol. The aqueous solution is acid 
to litmus. 

Dose. — Average dose : 2 grains (0.12 Gm. = 125 milligrammes), U. S. P. 

Zinci Stearas — Zinci Stearatus — Zinc Stearate. — Used in preparing unguen- 
tum zinci stearatis, 50 per cent. 

Zinci Sulphas — Zinci Sulphatis — Zinc Sulphate. — Origin. — Prepared by dis- 
solving granulated zinc in sulphuric acid, certain precautions being taken to remove 
impurities. 

Description and Properties. — Colorless, transparent, rhombic crystals, without odor, 
and having an astringent, metallic taste. Efflorescent in dry air. Soluble in 0.6 part 
of water and in 3 parts of glycerin ; insoluble in alcohol. Zinc sulphate should be kept 
in well-stoppered bottles. 

Dose. — 1-3 grains (0.06-0.18 Gm.) ; as an emetic, 10-60 grains (0.6-4.0 Gm.). 
[15 grains (1 Gm.), U. S. P.]. 

Unguentum Zinci Oxidi— Unguenti Zinci Oxidi— Ointment of Zinc Oxide 
(20 per cent.). — Used externally and locally. 

Zinci Valeras. — See Valerian. 



Antagonists and Incompatibles. — The salts of zinc are incom- 
patible with the vegetable astringents, alkalies and their carbonates, 
lime water, the sulphides, silver nitrate, lead acetate, and milk. 

Physiological Action. — Externally and Locally. — The soluble 
zinc salts resemble the lead salts in their action, but they are less 
powerful astringents. They are also to a slight extent hemostatic. 
The chloride is exceedingly caustic. The insoluble zinc compounds 
are mildly antiseptic and astringent. 

Internally. — Digestive System. — The sulphate of zinc and, in a 
slight degree, the carbonate are specific emetics, causing rapid 
emesis, with but little nausea or depression. It is believed that 
their effects are due to local action on the stomach. Central ner- 
vous action may play a part in the emesis. 

The salts of zinc also act as astringents upon the gastrointes- 
tinal mucous membrane. Dyspepsia, constipation, or diarrhea fre- 
quently follow its ingestion even in small quantities. 

Nervous System. — Zinc produces a depression of the central 
nervous system. When introduced intravenously, it may cause 
paralysis of the extremities. 

Circulation. — Zinc salts, when introduced into the circulation 
directly, cause a depression of the heart's action, resembling in 
that, as in other regards, the action of copper, with which metal its 
general effects are most closely allied. The blood-pressure is 
affected but slightly. The pulse is somewhat slowed, especially 
just before death. With the blood, zinc forms new hemoglobin 
compounds (zinc-hemol). 

Absorption and Elimination. — Zinc is taken up from the stomach 
and intestine and is found in largest quantities in the liver and bile. 
It is also found in the kidneys, pancreas, spleen, and thyroid. It 
is not held in the body in as stable a condition as the lead salts, 
and is less liable to bring about chronic poisoning. It is largely 
eliminated by the kidneys and bile. The salivary, milk, and intes- 
tinal secretions also eliminate some. In its passage through the 



422 A TEXT-BOOK OF MATERIA MEDICA. 

kidneys zinc is an irritant, causing, in poisoning, a parenchymatous 
nephritis. 

Untoward Action. — 3-5 grains (0.19-0.32 Gm.) have produced 
nausea and gastric oppression, while if the zinc salt reaches the 
intestines diarrhea results. When taken on a full stomach the salts 
form an insoluble albuminate which undergoes the regular digestive 
process. 

Repeated small doses, 3 grains (0.19 Gm.), have produced gas- 
tric oppression, eructations, slight confusion of thought, dizziness, 
bodily exhaustion, thirst, gastralgia, vomiting, and diarrhea. Zinc 
dyscrasia may follow, characterized by obstinate constipation, ema- 
ciation, and anemia. 

Poisoning. — Continued use or excessive doses of zinc will pro- 
duce poisoning, with symptoms resembling those of lead-poisoning. 

Chronic Zinc-poisoning. — Among zinc workers there is a type 
of poisoning known as " zinc-founders' fever" or ague. The attacks 
frequently are acute. After pouring a mold the worker may have 
a sense of general distress, with backache and irregular muscular 
pains and lassitude. There is no disturbance of the pulse or of 
temperature. Shortly following this chills may develop, the pulse 
is increased to 100 or 120, and there are cough, pain in the chest, 
and headache. Profuse perspiration marks the climax of the attack, 
and the patient has labored sleep and recovers. 

It is not improbable that the accompanying salts of arsenic and 
lead, always found in commercial zinc, are responsible, in part at 
least, for some of these symptoms. 

Treatment of Poisoning. — Chemical antidotes are the bicarbon- 
ates of soda and potassium. Flour and water, soapsuds, and milk 
are also beneficial. Morphine given hypodermically relieves the 
vomiting. Laxatives and potassium iodide may serve later to 
assist in eliminating the zinc. 

Therapeutics. — Zinc Oxide. — Externally and Locally. — The 
ointment or powder is used in chronic eczema, intertrigo, burns, fis- 
sured nipples, anal fissure, ulcers, and skin diseases. In combination 
with linseed oil the oxide has also been used in erysipelas. The 
drug has proved useful as an injection in leucorrhea. 

Internally. — Associated with bismuth, sodium bicarbonate, or 
belladonna, it is very effective in diarrhea — particularly the summer 
diarrhea of children — and dysentery. 

It is a most excellent remedy for colliquative sweating and the 
szveating of phthisis, and also serves to check the profuse secretion 
of bronchorrhea, although its use may occasion disordered diges- 
tion, since zinc is but sparingly soluble. 

The oxide is valuable in gastralgia. 

Zinc Acetate. — It is used only externally and as an injection 
in gonorrhea and Icjicorrhca. In conjunctivitis it is useful as a 
collyrium. 

Zinc Sulphate. — Externally and Locally. — The external use is 
chiefly in weeping eczema, pruritus, and ulcers. Locally it is of ser- 



HEA VY METALS USED FOR LOCAL PURPOSES. 423 

vice as a wash in ophthalmia and conjunctivitis, and as an injection 
in gonorrhea, leucorrhea, vulvitis, and otitis. It is also used in gan- 
grenous stomatitis, cancrum oris, and as a gargle in enlarged tonsils 
and relaxed sore throat. In nasal polypi the powder is insufflated, 
the solution being applied to the stump after removal of the poly- 
pus. It dries up soft tumors near the vagina, anus, and female 
urethra. 

Internally. — Its chief use is that of an emetic after ingestion of 
poison, irritating foods, and especially narcotics, as well as where 
the air-passages are obstructed, as in croup and diphtheria. 

It acts as an astringent in chronic diarrhea and dysentery when 
associated with opium and ipecac. 

Zinc Carbonate. — This preparation is used only externally, for 
blisters, weeping eczema, and intertrigo. It is employed in the form 
of a powder, but generally as an ointment — cardamine ointment. 

Zinc Iodide. — This salt is but little used, but is of some value 
as a gonorrheal injection, as an application to enlarged and indu- 
rated tonsils, and in scrofulous glands. 

Zinc phosphide and zinc valerianate are used only for the 
benefit derived from the phosphorus and valerianic acid, and may 
properly be omitted here. 

A long list of newer compounds of zinc have been given by the 
synthetic chemists. Some are of service, but they should be 
employed with understanding.. The most important are the borate, 
chrysophanate, cyanide, gynocardate, hemol, zinc ichthyol, sul- 
fonate, permanganate, salicylate, sozo-iodolate, stearate, subgallate, 
and sulphocarbolate. 

Administration. — Externally the powder or ointment of zinc 
oxide is used, or the drug may be mixed with powdered starch, 
lycopodium, or acacia. Before applying these preparations it is 
well to wash the parts with a weak solution of carbolic acid. 

Internally, \ grain (0.01 Gm.) zinc oxide and 3 grains (0.19 Gm.) 
sodium bicarbonate are given in diarrhea, or, if preferable, bismuth 
subnitrate 10 grains (0.64 Gm.), pepsin (Sheffer's) 3 grains (0.19 Gm.), 
and zinc oxide \-\ grain (0.03-0.06 Gm.), with a little opium added. 

As an injection a combination of 10 grains (0.64 Gm.) each of 
zinc sulphate and lead acetate is used, the two salts interacting and 
producing lead sulphate — which is precipitated and insoluble — and 
zinc acetate. 

Locally and externally the dry powder of zinc sulphate is used, 
or a mixture of zinc sulphate 10 grains (0.64 Gm.), aqua rosae 4 
ounces (118.29 Cc), and glycerin 1 dram (4.0 Cc), as a lotion. 
As an injection it is associated with lead acetate, forming the zinc 
acetate and lead sulphate. In ophthalmia neonatorum zinc sulphate 
5 grains (0.32 Gm.), morphine sulphate 3 grains (0.19 Gm.), and 
aqua rosae 1 ounce (30 Cc), perhaps with atropine added, form 
an excellent mixture. 

Internally, in dyspepsia 1-2 grains (0.06-0.12 Gm.) may be given, 
and for intestinal affections 1 grain (0.06 Gm.) each of the sulphate, 



424 A TEXT-BOOK OF MATERIA MEDIC A. 

powdered opium, and ipecac three times daily. To produce emesis 
5 grains (0.32 Gm.) are sufficient. 

The collyrium consists of \ grain (0.03 Gm.) of the salt in 1 
ounce (30 Cc.) of rose water. 

COPPER, 

Cupri Sulphas— Cupri Sulphatis— Copper Sulphate. 

V. 8. JP. 

Origin. — Prepared by neating copper and sulphuric acid together, dissolving the 
soluble product in hot water, and evaporating. 

Description and. Properties. — Large, transparent, deep-blue, triclinic crystals, 
odorless, of a nauseous, metallic taste ; slowly efflorescent in dry air. Soluble in 
about 2.6 parts of water and in 0.5 part of boiling water ; almost insoluble in alcohol. 

Dose. — J— ^ grain (0.008-0.03 Gm.) [| grain (0.03 Gm.), U. S. P.] as an 
astringent ; as an emetic, 2-20 grains (0.12-1.2 Gm.) [4 grains (0.24 Gm.), U. S. P.]. 

Antagonists and Incompatibles. — Alkalies and their carbon- 
ates, the sulphides, mineral salts (except the sulphates), lime water, 
the iodides, and vegetable astringents. 

Physiological Action. — Copper sulphate is the salt mostly 
used, and the only official preparation. Its action is therefore given 
as characteristic of that of cuprum. 

Externally. — Applied to the unbroken skin it produces little 
effect, but on raw surfaces or mucous membranes it acts as an 
astringent. In large quantities it acts as a caustic. It also pos- 
sesses antiseptic properties. 

Internally. — Digestive System. — It acts as an irritant, causing 
vomiting of greenish matter, though nausea does not follow the 
emesis. The secretions are augmented, and salivation and purg- 
ing of blood and mucus are attendant consequences of its inges- 
tion. Should emesis be delayed, the stomach should immediately 
be emptied, otherwise the copper is liable to produce inflammation. 

Nervous System. — It acts as a depressant. 

Circulatory System. — Copper exists normally in the blood, and 
acts as a tonic, being present in the circulation as an albuminate, 
or, as Kobert describes, a new compound, cuprohaemal. It de- 
presses the heart's action, causing a small, weak, rapid pulse. 

Respiratory System. — Its influence is to hasten and depress the 
respiratory movements. 

Absorption and Elimination. — Copper salts are slowly absorbed, 
tending to accumulate in the liver. The drug is eliminated by the 
liver, kidneys, salivary glands, and intestinal canal. 

Poisoning. — Acute poisoning results from the inhalation of 
cupreous fumes, eating fruits cooked in copper vessels, or from an 
overdose of a copper salt. 

When inhaled the first symptoms are those of bronchial catarrh 
and irritation. Internally administered, the symptoms do not usually 
appear at once, but after an hour's interval there are manifest a 
strong metallic taste in the mouth, burning and constriction of the 



HE A VY METALS USED FOR LOCAL PURPOSES. 425 

pharynx and fauces, salivation and vomiting of greenish matter, and 
purging, the passages after a while containing mucus streaked with 
blood. There are present also burning in the epigastrium, and 
griping, colicky pains. 

Copper enters the circulation quickly, it being highly diffusible. 
A characteristic symptom of poisoning is a green line on the gums. 
Sometimes jaundice may be present, and headache, convulsions, 
suppression of urine, cardiac depression, and hurried respiration are 
among the graver symptoms. 

Treatment of Poisoning. — A chemical antidote should be given 
at once, potassium ferrocyanide being the best, as it forms an in- 
soluble copper cyanide. Other recourses are white of egg, milk, 
sweet oil, emetics, and the use of the stomach-pump. A mustard 
plaster, with a little opium added to allay the pain and irritation, 
may be applied over the pit of the stomach as a counterirritant. 
Should vomiting have already occurred, emetics should be withheld. 

Chronic poisoning is thought to result from long-continued use 
of the medicine or from taking minute quantities of copper as found 
in the many foods that are treated with copper salts. The acute 
symptoms are described the same as those of acute poisoning, with 
the following superadded : paresis of the limbs, paralysis, inco-ordi- 
nation of muscles, atrophy of the liver, with fatty degeneration of 
the liver-cells, and proliferous growth of the connective tissue. 
There may also be present congestion of the lungs and fatty degen- 
eration of the kidney, together with bronchial catarrh. It is by no 
means certain that these symptoms are due to the copper alone or 
to lead and arsenic, which are so frequently associated with it, par- 
ticularly in foundries, etc., where these symptoms are noted. In 
view of the value of copper as a general disinfectant, the metal and 
its salts being markedly bactericidal, the question of chronic poi- 
soning merits detailed investigation. 

Therapeutics. — Externally and Locally. — Copper sulphate 
stimulates old, flabby, granulating ulcers. Ringworm, scabies, and 
tinea sycosis derive great benefit from its use. 

The crystal or solution, 2 grains to 1 ounce (0.12-32.0 Gm.) of 
water, is used extensively in conjunctivitis, tinea tarsi, and trachoma 
condylomata, and as a gargle in relaxed sore throat. The aphthae 
in aphthous stojnatitis are benefited by touching with the copper 
sulphate solution. It is also used as an injection in gonorrhea and 
gleet, 2 grains to 1 ounce (0.12-32.0 Gm.). It is also valuable in 
mercmial sore mouth and gangrene of the pharynx. 

Internally. — Copper sulphate is the chemical antidote for 
phosphorus-poisoning, yet it should be given with great caution, 
lest of itself it produce acute poisoning. It is a speedy emetic, 
since it acts directly upon the stomach. If emesis is not produced 
by the first dose, sulphate of zinc or mustard may be employed. 
It is used as an emetic in croup. 

In chronic dysentery and diarrhea an enema of a pint of water 
(512.0 Gm.) and 10 grains (0.64 Gm.) of sulphate of copper is an 



426 A TEXT-BOOK OF MATERIA MEDICA. 

efficient remedy, being by some authors considered the best metallic 
astringent in chronic dysentery. 

Copper associated with arsenic is highly beneficial in anemia. 

Oleate of copper is used in the skin affections mentioned. 

Nitrate and acetate of copper act like the sulphate. 

Arsenite of copper has been suggested as a remedy in anemia, 
and has been used in doses of y^- grain (0.0006 Gm.) in diarrhea 
and cholera infantum. 

Administration. — For an enema in diarrhea and dysentery it 
may be combined with opium — 2 grains to I ounce (0.12-32.0 Gm.) 
of water being used. For eye affections the crystal or solution is 
employed. In addition to the enema, copper sulphate, 1 grain (0.06 
Gm.), may be united with magnesium sulphate I ounce (32.0 Gm.) 
and 1 dram (4.0 Gm.) of diluted sulphuric acid in 4 ounces (128.0 
Gm.) of water, a tablespoonful of the mixture being given every 
three or four hours. To produce emesis 10-15 grains (0.6-1 Gm.) 
are dissolved in about 5 ounces (160.0 Gm.) of water, a tablespoon- 
ful being given every ten minutes until vomiting is produced. 

SILVER, 

Argenti Cyanidum— Argenti Cyanidi— Silver 
Cyanide. U. &. P. 

Origin. — Obtained by distilling a solution of potassium ferrocyanide acidulated 
with sulphuric acid, the distillate passing into a receiver containing a solution of silver 
nitrate. The process should be continued until the distillate no longer produces a 
precipitate in the receiver. The precipitate is finally washed with distilled water and 
dried. It should contain not less than 99.9 per cent, of pure silver cyanide, corre- 
sponding to 80.48 per cent, of metallic silver. 

Description and Properties. — A white powder, without odor or taste ; per- 
manent in dry air, but gradually turning brown on exposure to light. Insoluble in 
water, alcohol, or cold nitric acid ; soluble in boiling nitric acid, ammonia water, and 
solution of sodium hyposulphite or potassium cyanide. It should be kept in dark, 
amber-colored vials, protected from light. Not used internally. 

Argenti Nitras— Argenti Nitratis— Silver Nitrate. 

U. 8. 2\ 

Origin. — Obtained by dissolving silver in nitric acid with the aid of heat, evap- 
orating, and crystallizing. 

Description and Properties. — Colorless, transparent, tabular, rhombic crys- 
tals, becoming gray or grayish-black on exposure to light in presence of organic matter. 
Without odor, but having a bitter, caustic, and strongly metallic taste. Soluble in 0.6 
part of water and m 26 parts of alcohol. It should be kept in dark, amber-colored 
vials, protected from light. 

Dose. — %-l grain (0.015-0.06 Gm.) [I grain (0.01 Gm.), U. S. P.]. 

Official Preparations. 

Argenti Nitras Mitigatus— Argenti Nitras Mitigati —Mitigated Silver Ni- 
trate 1 MITIGATED Caustic). — Origin. — Prepared by fusing together silver nitrate, 30, 
and potassium nitrate, do, and casting in suitable molds. 

Description ami Properties. — A white, hard solid, generally in the form of pencils 
or cones of a finely granular fracture, becoming gray or grayish-black on exposure to 
light in the presence of organic matter ; odorless, having a caustic, metallic taste, 



HEA VY METALS USED FOR LOCAL PURPOSES. 427 

neutral to litmus-paper. It should be kept in dark, amber-colored vials. Used 
externally. 

Argenti Nitras Fusus — Argenti Nitratis Fusi — Molded Silver Nitrate 
(Lunar Caustic). — Origin. — Obtained by melting silver nitrate, 100, hydrochloric 
acid, 4, and pouring the melted mass into suitable molds. 

Description and Properties. — A white, hard solid, usually cone- or pencil-shaped, 
of a fibrous fracture, becoming gray or grayish-black on exposure to light in presence 
of organic matter ; odorless, having a bitter, caustic, and strongly metallic taste. Sol- 
uble in 0.6 part of water and in 26 parts of alcohol. The product should be kept in 
dark, amber-colored vials, protected from light. Used externally and locally. 

Argenti Ox idum— Argenti Oxidi— Silver Oxide. 

U. S. P. 

Origin. — Prepared by shaking a solution of silver nitrate with solution of potassa 
and washing the precipitate. 

Description and Properties. — A heavy, dark, brownish-black powder, liable 
to reduction by exposure to light ; odorless, with a metallic taste ; very slightly soluble 
in water and insoluble in alcohol. 

Dose. — %-2 grains (0.03-0.12 Gm.) [1 grain (0.065 6m.), U. S. P.]. 

Antagonists and Incompatibles. — The silver nitrate is incom- 
patible with the alkalies and their carbonates, chlorides, hydro- 
chloric and tannic acids, potassium iodide, solutions of arsenic, and 
many of the organic acids. 

Silver oxide is rapidly oxidized, forming explosive compounds 
with chlorides and organic substances. 

Synergists. — Preparations of copper, lead, and zinc aid the 
action of silver salts. 

The silver nitrate and its preparations and the silver oxide are 
the only salts which possess any value as astringents or caustics. 
The silver nitrate is the typical astringent salt, and its physiological 
action will be hereafter considered. 

Physiological Action. — Metallic silver is practically of no use 
in medicine, though of great value in surgery, because of its inert- 
ness. Silver nitrate is the salt of silver chiefly employed. 

Externally and Locally. — It is a powerful caustic, but does not 
wound very deeply, as it forms an eschar by coagulating the albu- 
min of the tissue, thus protecting the underlying structures. The 
eschar is white, but on exposure to light very soon becomes black, 
owing to the fact that the silver is reduced to its metallic state. 
The albuminate is soluble in chloride. 

Like lead salts, silver salts are hemostatic. They are severely 
irritant to mucous membranes when used in solution. Soluble 
silver salts are actively bactericidal. 

Internally. — Digestive System. — Weak solutions are astringent 
to mucous membranes, first contracting then dilating the blood- 
vessels. Stronger solutions are caustic. Weak solutions cause 
increased secretion of intestinal glands and larger flow of bile. 
The nitrate is frequently precipitated as the insoluble chlorides in 
the stomach and is later absorbed as an albuminate. 

Silver salts have little or no action on the general functions of 
the body. 



428 A TEXT-BOOK OF MATERIA MEDICA. 

Absorption and Elimination. — It is absorbed from the stomach 
and eliminated very slowly, chiefly by the feces, a small portion 
being excreted by the kidneys. 

Untoward Action. — Long-continued use of silver nitrate pro- 
duces discoloration of the skin (argyria), either general or more 
pronounced in particular spots, such as the face. Even when the 
skin is perfectly intact the application of nitrate of silver will dis- 
color it, and \ grain (.016 Gm.) has caused palpitation of the heart 
and irregular pulse. Silver accumulates in the tissues. 

Poisoning. — A poisonous dose of silver nitrate produces a violent 
gastro-enteritis. The earliest symptom is an intense pain in the 
abdomen, followed by vomiting and purging. The abdominal 
muscles are hard and retracted, the face livid and covered with 
perspiration and wearing an anxious expression. The lips are 
blanched, gradually becoming black ; the vomited matter is black- 
ish and sometimes resembles milk-curds. 

Epileptiform convulsions, delirium, and paralysis ensue, the 
latter symptom being of centric origin. 

Death results from shock. A large amount of mucus is thrown 
into the bronchial tubes by the lining mucosa. 

Treatment of Poisoning. — The chemical antidote is common salt. 
It is essential to protect the mucous membrane of the esophagus 
and stomach, and at the same time dilute the poison as much as 
possible, for which purposes large quantities of salt water and soap 
water or milk are valuable. Opium allays the pain and irritation. 

Chronic poisoning, or argyria, results from prolonged medicinal 
use of silver nitrate or its employment as a hair-dye for any length 
of time. The drug is deposited in all parts of the body, being 
especially manifest in a slaty, permanent discoloration of the skin. 
The first symptoms are discoloration of the sclerotic conjunctivae 
and a dark line on the inner side of the lips. Ulcerative stomatitis 
may occur, or even gastric ulcer. 

Treatment of Chronic Poisoning. — There is no known method 
of curing argyrosis when once developed. One hundred and fifty 
grains seem the limit. If more than this amount of the silver be 
given the discoloration is apt to occur. Considerable individual 
variation exists. Localized argyrosis has been known to occur 
after continued local applications of nitrate of silver to the larynx 
and pharynx. 

Therapeutics. — Externally and Locally. — A very important use 
of silver nitrate is that of preventing ophthalmia neonatorum, 
a 2 per cent, solution being dropped into the eyes. For adults a 2 
to 4 per cent, solution is used in various forms of conjunctivitis, the 
eyelids being painted with a camel's-hair brush, and the solution 
being washed off immediately to prevent discoloration. The nitrate- 
of-silvcr stick may also be used. 

Felons, boils, and bedsores may sometimes be aborted by the 
use of a strong solution — 20 grains to 1 ounce — of silver nitrate. 

An injection of 2-3 grains (.12-20 Gm.) to the pint is beneficial 






HE A VY METALS USED FOR LOCAL PURPOSES. 429 

in subacute gonorrhea and leucorrhea. This may also be used as 
a wash in pruritis ani and vulvce, to relieve the itching. The stick 
may be applied to uterine ulcers. 

As a caustic it is used in indolent ulcers and chancroids, stimu- 
lating them and producing a healthy granulating surface. 

After a cold, when the throat feels raw and sore, an application 
of 10 grains (0.6 Gm.) to the ounce (30.0 Cc.) is very beneficial, 
and the same may be used in inflammations of the pharynx, fauces, 
and mouth. A spray of 10 grains (0.6 Gm.) to the ounce (30.0 
Cc.) is very effective in laryngeal croup, tracheitis, chronic ulceration 
of the larynx, and whooping-cough. The caustic pencil is used in 
tonsillitis, sore nipples, mercurial sore mouth, and poisoned, lacerated, 
and punctured wounds. A solution of 1-2 grains (.06-. 12 Cc.) to 
the ounce (30.0 Cc.) is valuable in otorrhea, vesical catarrh, and 
balanitis. 

Internally. — Dr. Pepper recommends this salt in intestinal ulcer- 
ations, given in keratin-coated pills. It is excellent for gastric ulcer, 
in which it may be combined with opium. Gastralgia and chronic 
gastritis, ulcer -ation of the rectum, dysentery, and diarrhea of typhoid 
have been remarkably benefited by its use. For stomach affections 
\-\ grain (.01-016 Gm.) is given, and for intestinal an enema of 
3-10 grains (.20-64 Gm.) to the ounce (30.0 Cc). 

It has been used in congested conditions of the cord, locomotor 
ataxia, epilepsy, and chorea. It is of no permanent value in any of 
these conditions. 

Argentic oxide is not so active as the nitrate. It has been 
employed for checking sweats, and, owing to its less caustic action, 
it may be preferable to the nitrate in gastric ulcer and gastralgia. 

Administration. — The dose of silver nitrate is \-\ grain (.01- 
.016 Gm.), and for a constitutional effect should always be given in 
pill form during the process of digestion. 

The keratin-coated pill is to be administered for intestinal dis- 
orders, and when a local action on the alimentnry canal is desired 
an ordinary pill should be given one to two hours before meals. 

It is well to discontinue the drug for a short time after three 
or four weeks treatment, the salt being so slowly eliminated that 
its prolonged use is very apt to result in argyria. 

Newer Preparations of Silver. 

Within recent years a number of new compounds of silver have 
been placed on the market. These have been devised to obviate, 
in part, the irritating effects of silver nitrate, as well as to avoid the 
limited action of this drug because of its property of coagulating 
proteids. Further, in internal therapy, since chlorides form insol- 
uble compounds, these newer bodies have been made to avoid this 
chemical change. Among the more important of these may be 
mentioned : Argentol, argonin, argentamin, protargol, largin, actol, 
itrol, ichthyargon, and colloidal silver (collargolum). 



430 A TEXT-BOOK OF MA TERIA MEDICA. 

Argentol. — This is a synthetic compound of quinaseptol and silver, which breaks 
up into oxychinolin and metallic silver. It is non-caustic, and is valuable in surgical 
wounds, skin affections, and has been employed in gonorrhea, but is not so valuable as 
protargol for this disease. 

Argonin. — Origin. — A soluble compound of silver and casein, first prepared by 
Rohmann and Liebreich. 

Description and Properties. — A dilute solution of this substance in water is opales- 
cent ; opaque when concentrated, but immediately cleared by the addition of ammonia 
or carbonate of soda. Used externally and locally. 

Argentamine. — In order that a deeper action of silver might result, this solution 
of silver phosphate in aqueous solution of ethylendiamine was prepared. It was 
found, however, that the amine was too irritating, and this preparation has but limited 
application. 

Protargol. — This product is the result of the attempt to obtain a compound of 
silver with an organic substance, albumose, which should be soluble and unirritating, 
and yet have the strong bactericidal properties of the metallic silver. It is a yellow 
powder, readily soluble in water, and contains 8.3 per cent, of silver. The solution is 
not affected by heat, albumin, hydrochloric acid, sodium chloride, or caustic soda. It 
is but slightly irritating, and has proved one of the best agents in the treatment of 
gonorrhea yet given to the profession. It is employed in from 2 to 10 per cent, 
solutions, depending upon the irritability of the affected parts and the stage of the 
disease. 

Largin. — This is a compound of much the same character as protargol, being silver 
combined with protalbin (Danilewsky), a paranuclein proteid prepared by Lilienfeld. 
This proteid combination is a gray powder, soluble in 9 parts of water, containing 11.1 
per cent, of silver, and is not precipitated by chlorides nor by albumin. It is used in 
much the same manner as protargol. It is used in x / 2 to 2 per cent, solutions. 

Actol. — This is lactate of silver, a white powder, odorless, tasteless, and soluble in 
20 parts of water. It has been recommended as an antiseptic, and fulfils much the 
same indications that silver nitrate does. 

Itrol. — This is similar to actol, being the citrate of silver. It is much less soluble 
in water — 1—4000. It has no advantages over the nitrate. 

Ichthyargon is a combination of silver and ichthyol. Its position in therapy is not 
yet established. 

Colloidal Silver (Collargolum). — Finely divided metallic silver was introduced 
by Crede as an antiseptic in 1898. By the process of trituration metallic silver is con- 
verted into a soluble form, making, with water, a brownish solution. In this form it is 
used in internal hypodermic medication — yi-i per cent. (10-30 m.) — or the colloid 
silver is made up as an ointment. 

The ointment should be rubbed into a part for from twenty to thirty minutes, and 
has been highly praised for the treatment of lymphangitis, adenitis, boils, septicemia, 
erysipelas, puerperal fever, or other septic process, local or general. Failure to obtain 
results is said by its supporters to be due to insufficient rubbing. 

Much more extended observation is desirable before trustworthy conclusions may 
be drawn concerning the value of colloidal silver. It is desirable that the ointment 
be freshly made. 

ALUMINIUM. 

Alumen— Aluminis— Alum. 77. S. P. 

Origin. — Prepared by a complicated process from a mixture of aluminum silicate 
and iron sulphide by roasting, lixiviating with water, concentrating the solution, and, 
while hot, mixing with potassium chloride. Upon cooling the alum separates as a 
crystalline powder, which is purified by one or two recrystallizations. It should con- 
tain not less than 99.5 per cent, of pure aluminum and potassium sulphate A1.K(S0 4 ). 
f 12 H 2 0. 

Description and Properties. — Large, colorless, octahedral crystals, some- 
times modified by cubes, or crystalline fragments, without odor, but having a sweetish 
and strongly astringent taste. On exposure to the air the crystals are liable to absorb 
ammonia and acquire a whitish coating. Soluble in 9 parts of water and 0.3 part of 
boiling water; also freely soluble in warm glycerin. Insoluble in alcohol. 

Dose. — 5-40 grains (0.3-2.60 Gm.) ; as an emetic, 1-2 drams (4.0-8.0 Gm. ) \j l /z 
grains (0.5 Gm.), U. S. P.]. 



HE A VY METALS USED FOR LOCAL PURPOSES. 431 

Official Preparation. 

Alumen Exsiccatum — Aluminis Exsiccati — Dried Alum (Burnt Alum). — 
Origin. — Alum heated until it is deprived of its water of crystallization. 

Description and Properties. — A white, granular powder, without odor, possessing a 
sweetish, astringent taste and attracting moisture from the air. Very slowly but com- 
pletely soluble in 20 parts of water, and quickly soluble in 0.7 part of boiling water. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Alumini Hydroxidum— Alumini Hydroxidi— Alumi- 
num Hydroxide. U. S. I*. 

Origin. — This substance is found in nature as the rare crystalline mineral gibb- 
site of North America — the diaspore of Eastern Europe. The aluminum hydrate may 
be prepared by precipitating the solution of an aluminum salt with an alkali or alkali 
carbonate. 

Description and Properties. — A white light, amorphous powder, odorless 
and tasteless, permanent in dry air. Insoluble in water or alcohol, but completely 
soluble in hydrochloric or sulphuric acid, and also in potassium or sodium hydrate 
T. S. 

Dose. — 3-6 grains (0.2-0.4 Gm.). 

Alumini Sulphas— Alumini Sulphatis— Aluminum 
Sulphate. U. S. P. 

Origin. — It is occasionally found as an efflorescence near volcanoes and upon 
alum-slate. For medicinal use it should be prepared from aluminum hydrioxide, by 
dissolving it in the requisite quantity of dilute sulphuric acid. 

Description and Properties.— A white, crystalline powder, having a sweet- 
ish and afterward astringent taste; permanent in the air. Soluble in 1.2 parts of 
water, and much more freely in boiling water ; insoluble in alcohol. Used externally. 

Allied Compounds. 

Alumnol— Alumnol — Alumnol.— Origin.— This substance was discovered by 
Filehne of Breslau, and is a mixture of aluminum salts of naphthol-sulphonic acid, 
containing about 5 per cent, of aluminum and 15 per cent, of sulphur. 

Description and Properties. — It occurs as a light, odorless, white or reddish-white, 
non-hygroscopic powder, It possesses a sweetish and astringent taste, and is readily 
soluble in water or glycerin, less so in alcohol, and insoluble in ether. 

While becoming darker on exposure to the air, its properties are unaffected. Used 
externally and locally. 

Aluminum Aceto-tartrate.— C^m.— First prepared by Athenstadt by dissolv- 
ing 5 parts of basic aluminum acetate in a sufficient quantity of water by the aid of 2 
parts of tartaric acid, and evaporating the solution to dryness. 

Description and Properties.— It occurs in shining, almost colorless, amorphous 
masses, with a faint, acetous odor and an acidulous astringent taste. Soluble in water; 
insoluble in alcohol. Used externally and locally. 

Aluminum Boroformate.— O^m.— Prepared by heating together boric acid, 
formic acid, and alumina. 

Other combinations of aluminum are : Alsol (acetate), Boral 
(borotartrate), Cutol (borotannate), Galled (gallate), Sozal (alum- 
inum hydrate, dissolved in phenolsulphonic acid). Salumin (sali- 
cylate), and Tanned (tannate). They have the same indications 
as alumnol. 

Antagonists and Incompatibles. — The alkalies and their car- 
bonates ; lead, mercury, and iron salts ; tartrates and tannic acid. 
Synergists. — The vegetable and mineral astringents. 



432 A TEXT-BOOK OF MATERIA MEDICA. 

Physiological Action. — Externally and Locally. — Alum con- 
tracts the small blood-vessels and coagulates the albumin in the 
tissues, but in order to have any effect it must be applied to a 
denuded surface. It is also mildly escharotic, particularly if an- 
hydrous. The albuminate formed is soluble in an excess of pro- 
teid. Applied to the unbroken skin, it thickens and hardens it. 

Internally. — Digestive System. — Its first effect when taken into 
the mouth is to excite the salivary secretion, the albumin in it, as 
well as that of the buccal mucous membrane, being precipitated. 
When its astringent action takes effect the secretions are dimin- 
ished and the mucous membrane of the mouth and tongue is 
blanched and puckered. The enamel of the teeth is affected, 
breaking under its influence. 

The digestive juices are diminished in quantity and the pepsin 
precipitated. Constipation follows, though it may be preceded by 
a slight diarrhea. 

Taken in large doses, alum produces nausea, vomiting, purging, 
and abdominal pain. 

Under ordinary conditions aluminum salts have no action on 
the general functions. Thrown into the circulation hypodermically 
they have a profound influence on the nervous structures, but such 
results are of experimental interest alone. 

Absorption and Elimination. — As stated, alum is absorbed by 
the stomach and intestines ; it is eliminated by the kidneys and 
liver. 

Untoward Action. — The prolonged use of alum is very apt to 
produce a cough in persons having sensitive bronchi. 

Therapeutics. — Externally and Locally. — Alum is used to de- 
stroy exuberant granulations and verrucosities. It is an excellent 
hemostatic in epistaxis and bleeding from the gums, vagina, rectum y 
bladder , bites, and sockets of extracted teeth. 

It is much used for sore throat by public speakers and singers, 
and is also efficient in tonsillitis, particularly the follicular form, 
gangrenous pharyngitis, stomatitis ulcerosa, relaxation of the uvula 
and pharyngeal mucous membrane, swollen and overriding gums, 
and mercurial ptyalism. 

The destructive effect of alum upon the teeth must always be 
borne in mind : the alum stick or a swab is preferable whenever 
possible. If a mouth-wash or gargle be necessary, wash and brush 
the teeth well immediately after using the alum. 

Five grains (0.32 Gm.) to 1 ounce (30.0 Cc.) of water is an excel- 
lent preparation for ophthalmia, conjunctivitis, and trachoma, but 
must not be used if there is any corneal inflammation, as it is apt 
to cause ulcers. By adding milk or white of egg to the mixture 
its efficiency is greatly increased. This preparation is also very 
serviceable in preventing the discoloration of a " black eye." An 
injection of 5-10 grains (0.32-0.64 Gm.) to the ounce (30.0 Cc.) of 
water is much used in gonorrhea, leucorrhea, and gleet, and also 
for washing the vulva in pruritus. 



HE A VY METALS USED FOR LOCAL PURPOSES. 433 

Sweating of feet '; hands, and axillce, when excessive and fetid, is 
checked by the application of a lotion of powdered alum. 

Soaking a piece of cotton or lint with alum and placing it under 
an ingrowing toe-nail affords marked relief. 

Chilblains, old sores, and ulcers are also benefited by the use of 
alum. 

A spray, gargle, or insufflation has been used with good results 
in diphtheria, bronchorrhea, chronic laryngitis, aphonia due to atony, 
bronchitis, and whooping-cough. 

Internally. — Alum operates advantageously as an astringent in 
arresting gastric and intestinal hemorrhages, hematuria, and menor- 
rliagia. The diarrheas of typhoid fever, and chronic dysentery, and 
occasionally the acute forms, are often benefited by an alum enema. 

By checking absorption and producing emesis alum serves as an 
antidote for lead-poisoning, and is an efficient remedy in lead colic. 

Alumen exsiccatum is employed chiefly as an escharotic for 
fungous growths, and to stimulate indolent ulcers and mucous 
membranes with morbid secretions. 

Whenever the drug is used as a powder externally or for insuf- 
flation, powdered dried alum is the form to use. 

Administration. — The emetic dose of alum is 1-2 drams 
(4.0-8.0 Gm.) in syrup. Warm water will increase its action when 
retching begins. 

For internal use, 5-10 grains (0.32-0.64 Gm.), mixed with a 
little simple syrup or syrup of orange peel to prevent nausea, will 
be found beneficial. For collyria, 2-3 grains (0.12-0.20 Gm.) in 1 
ounce (30.0 Cc.) of water, or the alum curd, as already mentioned, 
may serve best. The curd may be separated by adding 2 drams 
(8.0 Gm.) of alum to 1 pint (473.0 Cc.) of milk, boiling, and straining. 

The gargle and injection can be used in strengths of 5-20 grains 
(0.32-1.29 Gm.) to 1 dram (4.0 Gm.). For insufflation the dried 
alum is employed. 

BISMUTH. 

Bismuthi Citras— Bismuthi Citratis— Bismuth 
Citrate. TJ. S. P. 

Origin. — Bismuth subnitrate and citric acid are boiled in sufficient water, and 
the precipitate washed and dried. It should contain not less than 58 per cent, nor 
more than 60 per cent, of pure bismuth oxide. 

Description and Properties. — A white, amorphous or microcrystalline 
powder, odorless and tasteless, permanent in the air. Insoluble in water or alcohol, 
but soluble in ammonia water and in solutions of the citrates of the alkalies. 

Dose. — 1-3 grains (0.06-0.2 Gm.) [2 grains (0.125 Gm.), U. S. P.]. 

Official Preparation. 

Bismuthi et Ammonii Citras — Bismuthi et Ammonii Citratis — Bismuth 
and Ammonium Citrate. — Origin. — Prepared by mixing bismuth citrate with dis- 
tilled water to make a paste, adding sufficient ammonia water to make a solution, fil- 
tering, evaporating, and drying on plates of glass. 

Description and Properties. — Small, shining, pearly or translucent scales, odorless, 

28 



434 A. TEXT-BOOK OF MATERIA MEDIC A. 

with a slightly acidulous and metallic taste, becoming opaque on exposure to the air. 
Very soluble in water, but sparingly soluble in alcohol. The product should be kept 
in well-stoppered bottles, protected from light. 

Dose. — i-io grains (0.06-0.6 Gm.) [2 grains (0.125 Gm.), U. S. P.]. 

Bismuthi Subcarbonas— Bismuthi Subcarbonatis— 
Bismuth Subcarbonate. U. S. P. 

Origin — Obtained by dissolving purified bismuth in nitric acid and water, decant- 
ing and filtering, mixing with ammonia water, washing the precipitate, and dissolving 
in nitric acid. The solution is then mixed with a solution of sodium carbonate, and 
the resulting precipitate collected and washed. It should yield not less than 90 per 
cent, of pure bismuth oxide. 

Description and Properties. — A white or pale yellowish-white powder, of 
somewhat varying chemical composition, odorless and tasteless, permanent in the air. 
Insoluble in water or alcohol, but completely soluble in nitric or hydrochloric acid, with 
copious effervescence. 

Dose. — 5-20 grains (0.3-1.2 Gm.) [7^ grains (0.5 Gm.), U. S. P.], 

Bismuthi Subgrallas— Bismuthi Subgallas— Bismuth 
Subgallate. V. S. JP. 

Definition. — Bismuth subgallate should yield not less than 52 per cent, nor more 
than 57 percent, of pure bismuth oxide. 

Official in the German Pharmacopoeia as Bismutum Subgallicum ; also known as 
dermatol. 

Description and Properties. — Although somewhat variable in chemical 
composition, bismuth subgallate approximates the following formula: C 6 H 2 (OH) 3 
C0 2 Bi(OH) 2 , which contains 56.49 per cent, of bismuth oxide, Bi 2 3 . An amor- 
phous, bright yellow powder, odorless, tasteless, and permanent in the air. Insoluble 
in water, alcohol, and in very dilute mineral acids. Readily soluble with decom- 
position in hydrochloric, nitric, and sulphuric acids, if these be heated, Alkalies dis- 
solve it readily, forming clear, yellow-colored solutions, which rapidly change to deep 
red. 

Dose. — Average dose : 4 grains (0.250 Gm. = 250 milligrammes), U. S. P. 

Bismuthi Subnitras— Bismuthi Subnitratis— 
Bismuth Subnitrate. U. S. JP. 

Origin. — Prepared by dissolving purified bismuth in nitric acid and water, con- 
centrating by evaporation, adding more water, stirring well, and washing and drying 
the precipitated bismuth subnitrate. It should yield not less than 80 per cent, of pure 
bismuth oxide. 

Description and Properties. — A heavy, white powder, of somewhat vary- 
ing chemical composition, odorless and almost tasteless, permanent in the air. Nearly 
insoluble in water and insoluble in alcohol, but readily soluble in nitric or hydrochloric 
acid. 

Dose.— 5-20 grains (0.3-1.2 Gm.) [7$ grains (0.5 Gm. ), U. S. P.]. 

Bismuthi Subsalicylas— Bismuthi Subsalicylatis— 
Bismuth Subsalicylate. U. S. I*. 

Definition. — Bismuth subsalicylate should yield not less than 62 per cent, nor 
more than 64 per cent, of pure bismuth oxide. 

Official under the names of Bismutum subsalicylicum (P. G.), Bismutum salicylicum 
(Swiss), Bismuthi salicylas (Br. P.). The composition varies somewhat, but is 
approximately C 6 H 4 (OHJCOjjBiO. 

Description and Properties.— A white, or nearly white, amorphous or 
crystalline powder, odor ess, tasteless, and permanent in the air. It is almost insoluble 



HE A VY METALS USED FOR LOCAL PURPOSES. 435 

in water ; on prolonged boiling with water, a more basic salt is formed through the 
splitting off of free salicylic acid. Alcohol or ether extracts salicylic acid, with 
decomposition of the salt. Acids decompose it, with separation of a white, flocculent 
precipitate of salicylic acid. 

Dose. — Average dose : 4 grains (0.250 Gm = 250 milligrammes), U. S. P. 

Unofficial Bismuth Compounds. 

A large number of bismuth compounds have been proposed for medicinal use in 
the last few years. The following may be mentioned as examples : Airol (bismuth 
oxyiodosubgallate), bismal (bismuth methylene digallate), bismutol (" bismuth 
sodium phosphate salicylate "), crurin (quinolin bismuth sulphocyanate), iodogalli- 
cin (bismuth oxyiodide methyl-gallol), other phenolates, the benzoate, the cinnamy- 
late (hetoform), the cresolate, the lactate, the bilactomonotannate (lactanines), the 
phenolsulphonate, the tannate, and similar salts ; also proteid compounds, as the pep- 
tonate; compounds with resorcin, pyrogallol (helcosol), etc. 



Bismuth Naphtholate. — Dose, 15-30 grains (1.0-2.0 Gm.). 

Bismuth Tribromphenate. — Dose, 60-75 grains (4.0-5.0 Gm.). 

Dermol (Bismuth Chrysophanate). — Description and Properties. — An amor- 
phous yellow powder, neutral in reaction, insoluble in water or alcohol. Used exter- 
nally and locally. 

Thioform. — A combination of bismuth, sulphur, and salicylic acid. 

Description and Properties. — A light, grayish-yellow powder, odorless and tasteless, 
insoluble in water, alcohol, or ether. Used externally and locally. 

Xeroform. — Tribromphenolate of bismuth, containing 50 per cent, of Bi 2 3 . It is 
a yellow, neutral, insoluble powder, tasteless, odorless, and non -irritating. It is used 
in doses of 8-15 grains (0.5-l.oGm. ) as an intestinal antiseptic. It is useful in fresh 
wounds, in gynecology, and in eczemas and prurigo. 

Orphal. — Beta-naphthol bismuth, containing 7 per cent, of oxide of bismuth and 
23 per cent, of beta-naphthol. It is a light-brown powder of pleasant taste, and splits 
up in the intestines into bismuth and beta-naphthol. It is used as an intestinal anti- 
septic in doses of 8-45 grains (0.5-3.0 Gm.). 

Eudoxin. — This is a bismuth salt of nosophan [q. v.). It is used in the same way 
as xeroform. 

There is a long list of other bismuth combinations, some of which may be found, 
after further observation, to be of service. 

Antagonists and Incompatibles. — The salts of bismuth are 
insoluble, and should not be prescribed with other agents in 
solution. 

Synergists. — The sedative action of bismuth upon the stomach 
may be increased by calomel and cerium oxalate, and pepsin may 
be given as a substitute for this purpose. The astringency of the 
bismuth salts may be enhanced by the addition of opium and 
tannic acid. 

Physiological Action. — Externally. — Bismuth salts are mildly 
astringent, but have no appreciable physiological effect upon the 
unbroken skin. 

Internally. — Digestive System. — Bismuth is insoluble in the 
gastro-intestinal juices. It coats the mucous membrane, lessening 
secretions and absorbing excess of free acids, at the same time act- 
ing as a sedative and feeble astringent. The tongue and stools are 
tinged a dark-clay color, due to conversion into the sulphide. The 



436 A TEXT-BOOK OF MATERIA MEDICA. 

soluble salts are absorbed very slowly, and increase the appetite 
and digestion, constipation being the result. 

In its general action bismuth is of interest only experimentally. 
In mammals intravenous injections of soluble salts cause slowing 
of the heart action, acceleration of the respiration, and irritative 
phenomena of the nervous system (convulsions). 

Absorption and Elimination. — The salts of bismuth are absorbed 
into the circulation, and are eliminated by the urine, liver, and feces. 

Untoward Action. — Odier noticed nausea, and Weenesk vomit- 
ing, colicky pains, diarrhea, or constipation, headache, sensation of 
heat, dizziness, and general debility. 

Poisoning. — It has always been assumed that cases of poisoning 
are due to the lead and arsenic contained in the bismuth prepara- 
tions, and few cases of poisoning are known from the internal use 
of bismuth. Local applications (dermatol) have given rise to 
gastro-intestinal irritation — salivation, sore gums, sloughing in the 
palate, etc. These symptoms disappear on removing the dressings. 

Therapeutics. — Externally and Locally. — Bismuth subnitrate 
is serviceable in intertrigo, erythema, acne rosacea, as a protective 
dressing for wounds, ulcers, and epithelioma, and as an application 
for chapped nipples and hands, relieving the smarting and itching. 
It is also of use in fissure, prolapsus ani, and superficial burns. 

It is used as an injection in gonorrhea, leukorrhea, and ozena, 
and was formerly used as an insufflation in acute nasal catarrh, 
being abandoned because of the arsenic which it sometimes con- 
tains. It serves as a wash in aphthous stomatitis, mild cases of 
mercurial salivation, and cancrum oris, as well as for the fetid 
sweating of feet and other parts, and for chancres and phlegmonous 
erysipelas. It has also proved beneficial in chronic conjunctivitis 
and granular lids or trachoma. 

Internally. — It allays irritation, and is consequently useful in 
irritative vomiting and diarrhea. Gastric pain is relieved by it. 
It is valuable in pyrosis, chroiiic diarrhea, gastric idccr, chronic 
dysentery, diarrhea of typhoid, early stages of cholera and cholera 
infantum, and in the gastritis due to alcohol. 

The citrate of bismuth and ammonium is very soluble, and 
should be used only for local applications. 

The oxide is insoluble, and combined with morphine has been 
used as a snuff in ozena and nasal catarrh. 

Subcarbonate of bismuth is frequently used as an intestinal 
antiseptic. 

Subsalicylate of bismuth reduces the pulse and temperature in 
typhoid fever, and also corrects fetid stools of indigestion diarrheas. 

Bismuth subgallate, or dermatol, was first used by Heintz 
and Liebrcich, being intended as a substitute for iodoform ; but it 
is very astringent, although not irritating. The preparation is used 
in weeping eczema, otitis media, herpes, wounds, bums, diarrhea, and 
dysentery. In stagnant ulcers it is of no service, since they need 
stimulation. 



HE A VY METALS USED FOR LOCAL PURPOSES. 437 

Bismuth citrate is insoluble, and is of no service medicinally. 

Besides the foregoing preparations there is a tannate of bis- 
muth, used to some extent in diarrhea, gonorrhea , leukorrhea, and 
ophthalmia. 

Phosphate of bismuth is the least soluble of all the bismuth 
compounds, and is used, but rarely, in diarrhea, dysentery, gastral- 
gia, and dyspepsia. 

Subiodide of bismuth is used as a substitute for the subnitrate, 
and is of special value in chronic ulcers. It is supposed to be 
slightly anesthetic. 

Subbenzoate of bismuth is mildly escharotic. 

Administration. — The drug is used externally as a powder or 
ointment in combination with naphthalin or vaseline, to which a 
little morphine may be added. Belladonna, opium, and oleate of 
bismuth are also used. 

For gastralgia and dyspepsia, pepsin or magnesium and calcium 
phosphate may be combined with bismuth. If a cathartic is desir- 
able, rhubarb may be added. 

Bismuth, aromatic powder, and carbo ligni make an excellent 
combination in flatulent dyspepsia. 

In infantile diarrhea and summer complaint bismuth 1 grain 
(0.06 Gm.), syrupus aurantii 15 minims (0.92 Cc), and calumba 15 
minims (0.92 Cc.) are efficacious, particularly as they allay the 
alternating pain. Large quantities of bismuth are advisable. 

Bismuth, 5-15 grains (0.32-1.0 Gm.), is given for stomach affec- 
tions, and 15 grains (1.0 Gm.) to 1 dram (4.0 Gm.) for intestinal 
disorders, one to two hours after meals as the stomach is emptied. 



CERIUM. 

Cerii Oxalas— Cerii Oxalatis— Cerium Oxalate. 

U. S. JP. 

(Cerous Oxalate.) 

Definition. — Cerium oxalate consists chiefly of a mixture of the oxalates of 
cerium, didymium, and lantharum, and of other rare metals of this group. 

Origin — Prepared by a complicated process by the action of acids, etc., upon the 
powdered mineral. 

Description and Properties. — A white, granular powder, without odor or 
taste, and permanent in the air. Insoluble in water, alcohol, or ether. 

Dose. — 1-8 grains (0.06-0.5 Gm.) [1 grain (0.065 Gm. ), U. S. P.]. 

Physiological Action. — The physiological action of this drug 
is imperfectly understood : it is supposed to be a nervous and 
gastric sedative. 

Therapeutics. — Internally. — Its widest application is in the vom- 
iting of pregnancy, but it also controls the emesis of uterine disease 
and of dyspepsia, due to gastric acidity or deranged innervation of 
the stomach, as in sea-sickness. 

It does not derange digestion, and is therefore of value in 



438 A TEXT-BOOK OF MATERIA MEDIC A. 

checking the cough of phthisis and bronchitis, especially when 
accompanied by vomiting. 

In combination with bismuth it is useful in checking diarrhea. 

Administration. — Cerium oxalate is usually administered in pill 
form, 1-3 grains (.06-.20 Gm.) three times daily, but the powder 
is used when the drug is associated with other remedies. 



VEGETABLE ASTRINGENTS. 



Acidum Tannicum— Acidi Tannici— Tannic Acid. 

U. S. I>. 

Definition. — A monobasic organic acid, C 13 H 9 O r COOH, obtained from nutgall. 

Description and Properties. — A light-yellowish, amorphous powder, usually 
cohering in the form of glistening scales or spongy masses ; odorless or with a faint 
characteristic odor and a strongly astringent taste ; gradually turning darker when ex- 
posed to air and light. Soluble in about 0.34 part of water and in 0.23 part of alcohol ; 
very soluble in boiling water and in boiling alcohol ; also soluble in about 1 part of 
glycerin with the assistance of a moderate heat ; freely soluble in diluted alcohol and 
sparingly in absolute alcohol ; almost insoluble in absolute ether, chloroform, benzol, 
or benzin. 

Dose. — 1-20 grains (0.06-1.2 Gm. ) [7J grains (0.5 Gm.), U. S. P.]. 

Official Preparations. 

Collodium Stypticum — Collodii Styptici — Styptic Collodion. — Used externally 
and locally. (Tannic acid, 20 ; alcohol, 5 ; ether, 25 ; collodion, to 100.) 

Glyceritum Acidi Tannici — Glyceriti Acidi Tannici — Glycerite of Tannic 
Acid. — Used externally and locally. (Tannic acid, 20; glycerin, 80.) 

Trochisci Acidi Tannici — Trochiscos (ace.) Acidi Tannici — Troches of 
Tannic Acid. — Dose, 1-3 troches. 

Unguentum Acidi Tannici — Unguenti Acidi Tannici — Ointment of Tannic 
Acid. — Used externally and locally. (Tannic acid, 20 ; glycerin, 20 ; ointment, 60.) 

Physiological Action. — Externally. — Tannic acid has little, if 
any, effect upon the unbroken skin. It is feebly antiseptic. Upon 
raw surfaces, however, it acts as a powerful astringent, contracting 
the tissues and coagulating the albumin. Urticaria and erythema 
sometimes follow its use. In weak solutions it tans dead skin. 
Locally applied to glandular structures, such as sweat glands, tannic 
acid causes a diminution in their secretions. 

Internally. — Digestive System. — By coagulating the albumins 
tannic acid imparts a dryness to the mouth, accompanied by a sen- 
sation of puckering. It partially paralyzes the sensory nerve- 
endings, thus blunting the sense of taste. Large doses produce 
vomiting by an irritant action, while diarrhea, followed by consti- 
pation, may be present. 

By its action on the stomach, pepsin and peptones are precipi- 
tated, unless the stomach contents are markedly acid, albumin is 
coagulated, and the secretion of gastric juice diminished, all of which 
actions tend to impair the digestive function. The tannates formed 
are all susceptible of digestion, however, and tannic acid is set free. 
There is a partial conversion of the tannic acid into gallic and pyro- 

439 



440 A TEXT-BOOK OF MA TERIA MEDICA. 

gallic acids. To facilitate absorption there must be a preliminary 
conversion of tannic into gallic acid, and this reaction takes place 
in the intestine. A diminution of peristalsis is followed by consti- 
pation. 

Nervous System. — No special effect has been observed. 

Circulatory System. — Its astringent property makes tannic acid 
a valuable hemostatic. It arrests hemorrhage partly by prelimi- 
nary contraction of the blood-vessels, but more particularly by 
coagulating the proteid of the blood. 

Absorption and Elimination. — As tannic acid combines so readily 
with the proteids of the intestinal canal it is not absorbed, as a rule, 
in large amounts. Some of the ingested tannic acid is eliminated 
unchanged by the intestines. Most of it is converted into gallic 
acid in the intestines, and as such is eliminated by the urine and 
stools. The tannate that is absorbed may be found in the blood, 
possibly a sodium salt of tannic or gallic acids. Sodium tannate 
may be found in the urine. Much of the tannic acid taken up is 
completely oxidized. 

Uterus. — No special influence other than arresting hemorrhage 
when locally applied has been noted. 

Untoward Action. — A dose of 3 grains (0.2 Gm.) may cause 
pain in the stomach and intestines. Following such a dose, there 
may be coating of the tongue, thirst, eructation of gas, and tenes- 
mus. A tendency to hemorrhoidal congestion is enhanced. 

Therapeutics. — Externally and Locally. — Tannic acid is a valu- 
able application for bedsores and tdcers. Its astringent property is 
of use in cases of intertrigo, impetigo, sycosis, sore nipples, and 
eczema of the chronic desquamating variety. It is beneficial in 
hyperidrosis of the hands and feet, of the axilla and genitals. 

The glycerite of tannin, applied locally in cases of otorrhea 
and ozena as sequelae of scarlet fever or measles, is of some benefit. 
The same preparation or a powder may be used in stomatitis, ton- 
sillitis, and pharyngitis, as well as in cases of spongy or ulcerous 
gums. The lozenges are beneficial in whooping-cough. Supposi- 
tories of tannic acid are employed for hemorrhoids, fissure, pro- 
lapse, and rectal tdcers. 

An aqueous solution of tannic acid is very useful in leukor- 
rhea. The glycerite and iodoform tannin are excellent agents in 
inflammatio?i of the cervix uteri. Tannic acid also dispels the odor 
and allays the discharges in carcinoma uteri, being applied as a 
vaginal douche. It is useful as a lotion in herpes and alopecia cir- 
cumscripta. Injection of the acid or insufflation of the powder into 
the urethra is of some value in gonorrhea. In acute dysentery 
much benefit maybe derived from an enema of 10 grains of tannin 
added to a 4 per cent, solution of boric acid. It lessens pain and 
tenesmus and controls hemorrhage. 

Internally. — Tannic acid is styptic in intestinal hemorrhage and 
is valuable in treatment of diarrhea. It forms tannates when given 
as an antidote for poisoning by alkaloids and tartar emetic. Since 



VEGETABLE ASTRINGENTS. 441 

these tannates are more or less soluble, however, some drug should 
be given as a purgative. 

Administration. — For hematemesis powders of 10-20 grains 
are given. For effect upon the intestines it should be administered 
in pills, 3-5 grains, or it may be dissolved in the stomach. Locally 
it may be applied as a solution, glycerite, powder, suppository, or 
an ointment. Styptic collodion is a protection to lacerated or 
incised wounds. 

Organic Combinations of Tannin. 

Because of its irritating properties in the gastro-intestinal canal, tannic acid has 
been largely supplanted by a number of organic combinations. Among these are 
tannalbin, tannigen, tannoform, tannon (tannopin), and tannocol. 

Tannalbin. — Tins is a compound of tannin and albumin, heated to 120 F. It is 
obtained as a red-brown powder, and is decomposed by the alkaline secretions of the 
intestinal canal and not by the gastric juice. It is one of the best of these newer com- 
pounds in the treatment of intestinal diarrhea if such diarrheas call for astringent 
action. The dose of tannalbin is from 45-150 grains (3-10 Gm.) for adults, children 
in proportion. 

Tannigen. — This is a yellowish-gray powder — an acetic ester of tannic acid. It is 
odorless and tasteless, hygroscopic, insoluble in water, and slightly soluble in ether and 
alcohol. It acts best in the alkaline secretions, and is not acted on, or but slightly 
(Rost), by the gastric secretions. It is useful as an intestinal astringent in chronic 
diarrheas in about the same dosage as tannalbin. 

Tannoform. — This is a product of condensation formed by the action of formal- 
dehyd on gallotannic acids. It is a pale rose-colored powder, insoluble in water and 
soluble in alkaline solutions. It is valuable in diarrheas associated with much fermen- 
tation, and is also used as a topical application (as 10 per cent, ointment) in ozena, 
burns, hyperidrosis, pruritus, and hemorrhoids. Its dose internally is from 5-8 grains 
(0.25-0.5 Gm.). A number of tannoforms may be formed from the vegetable astrin- 
gents, such as rubus, juglans, rhatany, catechu, quercus, etc. 

Tannon, also called tannopin, is a combination of urotropin and tannin. It is a 
light-brown powder, insoluble in water and soluble in weak alkaline fluids. It has 
been recommended in diarrhea in 15-grain doses (1 Gm.). 

Tannocol. — This combination of tannic acid and gelatin is practically identical with 
tannalbin. 

Acidum Gallicum— Acidi Gallici— Gallic Acid. 

U. S. P. 

Definition.— An organic acid, C 6 H 2 (OH 8 )COOH + H 2 0, usually prepared from 
tannic acid. 

Description and Properties.— White or pale fawn-colored, silky, interlaced 
needles or tricolinic prisms ; odorless, having an astringent or slightly acidulous taste; 
permanent in the air. Soluble in 87 parts of water and in 4.14 parts of alcohol at 

25 C. 

Dose. — 5-20 grains (0.3-1.2 Gm.) [15 grains (1 Gm.), U. S. P.]. 

Physiological Action. — Gallic acid resembles tannic acid in its 
action, but does not coagulate albumin, and therefore does not 
possess the local influence of the latter. 

Therapeutics. — Externally and Locally. — Gallic acid is seldom 
used externally. Locally, tannic acid is preferable, but gallic acid 
is effectual applied as a glycerite, 1 dram-i ounce (4.0-32.0 Gm.), 
in cases of tonsillitis and pharyngitis. Gallic acid and stramonium 
ointment in equal parts form an unguent for hemorrhoids. In alco- 
holic solution it is applied to the membrane of diphtheria. 



442 A TEXT-BOOK OF MATERIA MEDICA. 

Internally. — It is doubtful if gallic acid has any distinct indi- 
cations. 

Administration. — Gallic acid is not to be combined with iron. 
It is administered in powder or pill form. The glycerite and the 
ointment are used locally. 

Related Compounds. 

Pyrogallic Acid is of use in acne, but produces a discoloration of the skin. 

Eugallol and Lenigallol, acetates of pyrogallic acid, have been advised as sub- 
stitutes of pyrogallic acid in psoriasis and acute and chronic eczemas. 

Pyrogallol, 2 grains (0.12 Gm. ), is used in internal hemorrhage. As an ointment, 
I dram to 1 ounce (4.0-32.0 Gm.), it is palliative in psoriasis, and it is also beneficial 
in lupus and epithelio??ia. 

Gallanol, the analid of gallic acid, is a bactericide, and is useful in psoriasis in the 
form of a powder or in an ointment ( I to 30). It is also used in alcoholic solutions of 
10 per cent, strength. It relieves the pruritus of chronic eczema. In favus and tricho- 
phytosis a mixture is used consisting of gallanol 10 parts, ammonia I part, and alcohol 
50 parts. 

Gallicine, methyl ether of gallic acid, applied in finely divided form with a brush. 
is a benefit in keratitis and conjunctivitis, as well as in eczema of the eyelids. 

Galla-Gallce-Nutgall. U. S. JP. 

Origin. — An excrescence on Quercus infectoria Olivier, caused by the punctures 
and deposited ova of Cynips tinctoria Olivier. 

Quercus infectoria is a small tree, or more often a shrub, 4 to 6 feet (1.2-1.8 M.) high, 
indigenous in the basin of the Mediterranean. 

Description and Properties. — Xutgalls are subglobular, about 1 inch (25 
Mm.) in diameter, more or less tuberculated above, otherwise smooth, heavy, hard; 
often with a circular hole near the middle communicating with the central cavity con- 
taining either the partly developed insect or pulverulent remains of it ; inodorous ; 
taste strongly astringent. 

Galla in substance is seldom given internally. 

Official Preparations. 

Tinctura Gallae— Tincturae Gallse— Tincture of Nutgall.— Dose, 1-2 fluid- 
drams (4.O-8.O Gm. ) [1 dram (4 Cc. ), U. S. P.]. 

Unguentum Gallae — Unguenti Gallae — Ointment of Nutgall. — Used exter- 
nally. 

Physiological Action. — Its action is that of tannic acid, which 
is derived from galls. 

Therapeutics. — Externally and Locally. — Galla, in combination 
with stramonium liniment or 1 dram (4.0 Gm.) of powdered opium 
to each ounce (32.0 Gm.) of nutgall ointment, is an excellent 
application for external hemorrhoids. For eczema of the scalp, 
herpes, pissured nipples, indolent ulcers, and chilblains nutgall oint- 
ment has proved beneficial, as well as for alopecia circumscripta 
and rectal prolapse. One part of powdered galls to seven or eight 
of vaseline is a most excellent application for lessening the cica- 
tricial contraction following extensive burns. Galla is used little 
locally, but is recommended as a gargle and wash, being applied to 
the relaxed mucous membranes of the mouth, vagina, and rectum. 

Administration. — Galls are used mostly in the form of an 
infusion or ointment. The tincture is seldom employed. 



VEGETABLE ASTRINGENTS. 443 

Quercus— Quercus— White Oak. U. 8. JP. 

Origin. — The dried bark of Quercus alba L., collected from trunks or branches 
ten to twenty-five years of age, and deprived of the periderm. The oaks are shrubs or 
trees growing chiefly in the temperate zone, often forming extensive forests. The white 
oak is a stately tree, 60 to 80 feet ( 18-24 M-) high, found from Canada to Florida and 
west to Wisconsin and Eastern Texas. 

Description and Properties. — In nearly flat pieces deprived of the corky 
layer, about \ inch (5 Mm.), pale brown ; inner surface with short, sharp, longitudinal 
ridges ; tough and of a coarse, fibrous fracture, a faint, tan-like odor, and a strongly 
astringent taste. As found in the shops, it is usually an irregularly coarse fibrous powder, 
which does not tinge the saliva yellow. 

Dose. — Seldom given in substance. A decoction is sometimes given internally, 
but the chief use of the drug is for external or local application. 

Official Preparations. 

Fluidextractum Quercus — Fluidextracti Quercus — Fluidextract of Quer- 
cus (U. S. P.). — Prepared from the official quercus (Quercus Alba, U. S. P., 1890), 
the bark of the white oak. The medicinal properties depend upon the tannin con- 
tained in the bark. 

Dose, — Average dose: 15 minims (i Cc), U. S. P. 

Physiological Action. — The general action is that of tannic 
acid. 

Therapeutics. — Externally and Locally. — It is used for chapped 
nipples, gangrene, ulcers, and dermatatis venenata. It is of value 
as an ointment in hemorrhoids, prolapsus ani, anal fissure, and leu- 
corrhea. The drug is also serviceable in relaxed uvida and as a 
tooth-powder. It stains the linen, however, which somewhat limits 
its use. Pessaries made of the bark have been used to check 
uteri7ie hemorrhage. For scrotal hernia the concentrated fluidextract 
is injected into the tissues for the purpose of exciting inflammation 
and consequent contraction of the hernial ring. It may be of 
service in diarrhea and dysentery. 

Administration. — Externally it is used as a poultice — chiefly 
in the form of the powdered bark. The decoction is employed 
almost exclusively as an injection and for internal administration. 
The laity were formerly wont to roast the acorns and chew them, 
or grate them and mix the gratings with cocoa or chocolate, 
believing them to be a cure for diarrhea as well as for flatulent 
dyspepsia and scrofula. 

Gambir— Gambiris— Gambir. TJ. 8. JP. 

Definition. — An extract prepared from the leaves and twigs of Ourouparia 
Gambir (Hunter) Bailion. Both drugs contain a large percentage of tannic acid and 
its compounds. Gambir was introduced on account of the difficulty of obtaining in 
the market true Acacia catechu. The Tinctura Catechu Composita and the Trochisci 
Catechu (U. S. P., 1890) are replaced by tinctura gambiris composita and trochisci 
gambiris. 

Description and Properties. — Irregular masses or cubes about 25 mm. in 
diameter, externally reddish-brown, pale brownish-gray or light brown ; fracture dull 
earthy, friable, crystalline, inodorous, bitterish, very astringent, with a sweetish after- 
taste. 

Dose. — Average dose : 15 grains (1 Gm. ), U. S. P. 

This takes the place of Catechu of the Pharmacopoeia of 1890. Catechu is an 
extract prepared from the wood of Acacia catechu (natural order of Leguminosae). 



444 A TEXT-BOOK OF MA TERIA MEDICA. 

Official Preparations. 

Tinctura Gambiris Composita — Tincturae Gambiris Compositse — Compound 
Tincture of Gambir. — Dose, \-2 fluidrams (2.0-8.0 Cc.) (Gambir, 50; Saigon cin- 
namon, 25 ; by maceration and percolation with diluted alcohol to 1000.) 

Trochisci Gambiris — Trochiscos (ace.) Gambiris — Troches of Gambir. — 
Dose, 1-6 troches. (Each troche contains I grain (0.06 Gm.) of gambir. 

Physiological Action. — Gambir and catechu do not differ in 
their action from tannic acid. Both gambir and catechu depend on 
tannic acid for their activity. They show no variations in thera- 
peutic activities. Being less soluble their action on the intestines is 
more prolonged. 

Kino— Kino— Kino. U. S. J*. 

Origin. — The inspissated juice of Plerocarpus Marsupium Roxburgh, a tree 
(called buja in Bengal) 60 to 80 feet (18-24 Mm.) high, indigenous in India and 
Ceylon. 

Description and Properties. — Small, angular, dark-brownish red, and trans- 
parent ; inodorous, very astringent and sweetish, coloring the saliva deep red. Soluble 
in alcohol, nearly insoluble in ether, and only slightly in cold water. 

Dose. — 10-20 grains (0.6-1.2 Gm.) [7^ grains (0.5 Gm.), U. S. P.]. 

Official Preparation. 

Tinctura Kino — Tincturae Kino — Tincture of Kino. — Dose, \-2 fluidrams 

(1.0-8.0 Cc.) [1 fluidram (4 Cc), U. S. P.]. 

Pysiological Action. — Its action is similar to that of tannic 
acid. It colors the saliva, stools, and diapers red. 

Therapeutics. — Externally and Locally. — Kino is an efficient 
dressing for flabby, indolent ulcers, acting as a stimulant. Yet the 
other astringents deserve precedence. As a gargle in pharyngitis 
and relaxed uvula kino is valuable, but, owing to its disagreeable 
taste, krameria is to be preferred. Owing to its speedy action it 
checks the hemorrhage in epistaxis where other astringents fail. 
In leukorrhea and gonorrhea an infusion or injection is serviceable. 

Internally. — In dysentery and chronic diarrheas with profuse 
serous discharges. It is less irritating than the other astringents. 

Administration. — The powder is used as an insufflation in 
epistaxis, and is dusted on ulcers. In diarrhea it is best to use 
kino in combination with opium or chalk mixture. The tincture is 
used internally. 

Krameria— Krameriae— Krameria. U. S. P. 

Origin. — The dried root of Krameria triandra Ruiz et Pavon, Krameria ixina 
L., and of Krameria argentea Martine. Low shrubs with spreading branches, native 
to Bolivia and Peru, growing in sandy localities in the mountains at an altitude of 3000 
to 8000 feet (90x5-2440 M.). 

Description and Properties. —From 1 to 1^ inches (25-38 Mm.) thick, 
knotty, and several-headed above, branched below, the branches long ; bark smooth, or 
in the thinner pieces scaly, deep rust-brown, ^ to ^ inch (1-2 Mm.) thick, very 
astringent, inodorous ; wood pale, brownish-red, tou^h, with line medullary rays, nearly 
tasteless. The root of Krameria ixina (Savanilla rhatany) is less knotty and slenderer, 
and lias a dark purplish-brown bark about y% inch (3 Mm.) thick. 

Dose. — 8-30 grains (0.5-2.0 Gm.) [15 grains (1 Gm), U. S. P.]. 



VEGETABLE ASTRINGENTS. 445 

Official Preparations. 

Extractum Krameriae — Extracti Krameriae — Extract of Krameria. — Dose, 
5-10 grains (0.3-0.6 Gm.) [7J grains (0.5 Gm. ), U. S. P.]. 

Fluidextractum Krameriae — Fluidextracti Krameriae — Fluidextract of Kra- 
meria. — Dose, 5-30 minims (0.3-2.0 Cc. ) [15 minims (1 Cc. ), U. S. P.]. 

Syrupus Krameriae — Syrupi Krameriae — Syrup of Krameria. — Dose, ^-4 
fiuidrams (2.0-16.0 Cc.) [1 dram (4 Cc), U. S. P.]. 

Tinctura Krameriae — Tincturae Krameriae— Tincture of Krameria. — Dose, 
%-2 drams (2.0-8.0 Cc.) [i dram (4 Cc), U. S. P.]. 

Trochisci Krameriae — Trochiscos (ace) Krameriae — Troches of Krameria. — 
Dose, 1-5 troches. (Each troche contains I grain (0.06 Gm.). 

Physiological Action. — The action of krameria is identical with 
that of tannic acid. 

Therapeutics. — Externally and Locally. — Its value as a topical 
application is of little consequence, but it has served satisfactorily 
as an ointment for hemorrhoids. It is used as an infusion or injec- 
tion of the diluted tincture or fluidextract in leukorrhea, gleet, and 
especially in anal fissure r , for which it has been highly recommended, 
since it checks the accumulation of feces in the rectum by constrict- 
ing its walls, rendering defecation less painful, and preventing the 
formation of ulcers. The powder is used in epistaxis and rectal 
bleeding, also in prolapsus ani and ozena of a non-specific nature. 
It is used extensively in the preparation of tooth-powders, being 
especially beneficial where the gums display a tendency to bleed 
readily. A mouth-wash and gargle are used in ptyalism, spongy 
gums, pharyrigitis , and relaxation of the uvula. Krameria has 
gained a wide reputation for allaying habitual, but not profuse, 
uterine hemorrhage. It is a good tonic for debilitated patients. It 
is also used in chronic diarrhea and dysentery. 

Administration. — The powder is used in the nose and rectum 
either by insufflation or by means of a pledget of cotton. As an 
injection and enema the fluidextract is used. In fissure of the 
anus the rectum must be emptied first by an enema ; then a solu- 
tion of the extract, 1 dram (4.0 Gm.) to 1 ounce (30.0 Cc.) of 
water, is emptied into the bowel and allowed to run out, repeating 
the process several times. This procedure is very painful at first, 
but as the fissure gradually heals the operation will cause the 
patient little, if any, pain. Keep the bowels open with a mild saline 
laxative. The success attending the operation warrants any dis- 
comfort which the patient may experience. The nasal douche is 
best in ozena, followed by an insufflation of the powder. 

Haematoxylon— Haematoxyli— Haematoxylon. 

U. S. P. 

( Logwood. ) 

Origin. — The heart-wood of Hcematoxylon campechianum L., a tree 30 to 40 feet 
(9-F2 M.) high, indigenous on the shores of the Gulf of Campeachy and in certain 
parts of South America. 

Description and Properties. — Heavy, hard, externally purplish-black, 
internally brownish-red, marked with concentric circles, splitting irregularly ; odor 
faint, agreeable, taste sweetish, astringent. When chewed it colors the saliva dark pink. 

Only the preparations of haematoxylon are used externally. 



446 A TEXT-BOOK OF MA TERIA MEDICA. 

Official Preparation. 

Extractum Haematoxyli — Extracti Haematoxyli — Extract of Haematoxy- 
Ion. — Dose, 5-15 grains (0.3-1.0 Gm.) [15 grains (I Gm. ), U. S. P.]. 

Physiological Action. — Its astringent properties are due to the 
tannin which haematoxylon contains. 

Therapeutics. — Externally and Locally. — It is a valuable anti- 
septic, as well as a healing application in gangrene and foul- 
smelling sores. It is also beneficial as an injection in leucorrhea. 
Haematoxylon has a very agreeable, sweetish taste ; hence it is well 
taken by children. It is of marked benefit in infantile diarrhea, but 
has the disadvantage of coloring the discharges and diaper blood- 
red or purplish blue, causing much alarm to the mother. The 
urine is also colored. It is used in dysentery, tuberculous diarrhea, 
and atonic dyspepsia. Some authorities claim that haematoxylon 
causes phlebitis. 

Administration. — In diarrhea a decoction with a little aromatic 
sulphuric acid is the best preparation. To it may be added a little 
syrup of ginger and camphorated tincture of opium. The decoc- 
tion is, in fact, the best preparation to use. 

Hamamelidis Folia— Hamamelidis Foliae— Hama- 
melis Leaves. TJ. S. P. 

(Witch-hazel.) 

Origin. — The dried leaves of Hamamelis Virginiana L., a shrub 6 to 10 feet 
(1.8-3.0 M.) high, growing in damp woods and thickets in Canada and the United 
States. 

Description and Properties. — Short-petiolate, about 4 inches (10 Cm.) 
long, obovate or oval, slightly heart-shaped and oblique at the base, sinuate-toothed, 
thickish, nearly smooth, inodorous ; taste astringent and bitter. 

Official Preparations. 

Aqua Hamamelidis — Aquae Hamamelidis — Hamamelis Water. — The final 
product here is a distillate, while the old Extractum Hamamelidis Fluidum is a percolate, 
now designated Fluidextractum Hamamelidis Foliorum. The aqua contains about 15 
per cent, of the alcohol. 

Dose. — Average dose: 2 fluidrams (8 Cc. ), U. S. P. 

Fluidextractum Hamamelidis Foliorum — Fluidextracti Hamamelidi Folio- 
rum — Fluidextract of Hamamelis Leaves. — Dose, 30 minims (2 Cc), U. S. P. 

Hamamelidis Cortex— Hamamelidis Corticis— 
Hamamelis. TJ. S. 2*. 

Both the bark and twig, and the leaves of Hamamelis Virginiana are now recog- 
nized by the Pharmacopoeia; the former are introduced under the above title and the 
old hamamelis (U. S. P., 1890) becomes hamamelidis folia. 

Dose. — Average dose : 30 grains (2 Gm.), U. S. P. 

Physiological Action. — The action of tannic acid is also that 
of hamamelis, save that the latter has a somewhat different influ- 
ence upon the circulation. 

Circulatory System. — Hamamelis acts on the muscular fibers of 
the veins, the modus operandi, however, not being satisfactorily 



VEGETABLE ASTRINGENTS. 447 

determined. Large doses produce severe throbbing headache and 
a sense of fulness of the blood-vessels. 

Therapeutics. — Externally and Locally. — F 'or sprains and bruises 
hamamelis is a favorite application, although some authorities re- 
gard it merely as a placebo. Locally, the fluidextract, with the 
addition of one-third its volume of glycerin, has been used in 
urticaria, rhus-poisoning, and phegmasia dolens. Owing to its 
marked sedative properties, hamamelis ointment is extremely bene- 
ficial in varicose ulcers, eczema, herpes, seborrhea, and acne rosacea, 
as well as in checking excessive secretions. It is also efficient in 
carbuncle, hyperidrosis, lupus erythematosus, burns, and frost-bites. 

The local action of the drug is important. The distilled 
extract, diluted with alcohol or water, is applied to inflamed gums, 
the nasal mucous membrane after removal of polypi, and in pharyn- 
gitis as a spray. As a suppository, or applied by means of a piece 
of cotton or wool soaked with the fluidextract, hamamelis affords 
a most grateful relief in bleeding piles, especially the internal vari- 
ety. In cystitis and hemorrhage from the bladder an injection of 
the diluted fluidextract or distilled extract is very valuable, 
besides being a most reliable topical application in capillary hemor- 
rhage from wounds, epistaxis, and bleeding after extraction of teeth. 
The ointment is used in rectal fissures and tilcers, and the lotion 
has been employed to some extent in chronic rheumatism, since 
it relieves the pain and stiffness in the muscles and joints. The 
decoction, with a little boric acid and a 1 per cent, solution of 
creasote, has been recommended as a gonorrheal injection. 

Administration. — The best preparation, both for internal and 
external use, is the distilled extract, although it is not official. The 
ointment and lotion are used externally, and the fluidextract 
internally. The preparations of hamamelis to be found in drug 
stores are unreliable unless they be perfectly fresh. 

Geranium— Geranii— Geranium. 77. S. P. 

(Cranesbill.) 

Origin. — The dried rhizome of Geranium maculatum L., a perennial herb with 
a stem 2 to 3 feet (30-60 Cm. ) high, very common in Canada and the United States 
westward as far as Kansas. 

Description and Properties. — Growth horizontal, cylindrical, 2 to 3 inches 
(5-7 Cm.) long and about y z inch (1 Cm.) thick; rather sharply tuberculated, longi- 
tudinally wrinkled, dark brown ; bark thin ; wood- wedges yellowish, small, forming 
a circle near the cambium line ; medullary rays broad, central pith large ; roots thin, 
fragile, inodorous ; taste strongly astringent. 

Dose. — 20-40 grains (1.2-2.40 Gm.) [15 grains (1 Gm.), U. S. P.]. 

Official Preparation. 

Fluidextractum Geranii — Fluidextracti Geranii — Fluidextract of Gera- 
nium. — Dose, 20-40 minims ( 1. 2-2. 40 Cc.) [15 minims (1 Cc. ), U. S. P.]. 

Physiological Action. — The action of geranium corresponds 
with that of tannic acid. 

Therapeutics. — Externally and Locally. — Geranium is not used 



448 A TEXT-BOOK OF MATERIA MEDIC A. 

externally. Its local action is varied. It is serviceable as an 
astringent gargle in sore throat ; as a mouth-wash in aphthous 
stomatitis ; in relaxed conditions of the rectum, vagina, and throat; 
in buccal ulcer, metrorrhagia and anal fissure ; in prolapsus ani and 
epistaxis. It has also proved valuable as an injection in leucorrhea, 
gonorrhea, and gleet. Owing to its mucilaginous taste, it is useful 
in infantile diarrhea and for persons having weak stomachs. 

Administration. — Locally, the powdered root and fluidextracts 
are used, but the fluidextract diluted with water is preferable. 
For an injection a decoction, i ounce (32 Gm.) to 1-2 pints 
(512-1024 Gm.) of water, is used, and the decoction in milk is 
of service in infantile diarrhea. 

Rhus Glabra— Rhois Glabrae— Rhus Glabra. 

77. S. JP. 

(Sumach.) 

Origin. — The dried fruit of Rhus glabra L., a shrub or suffruticose plant about 
12 feet (3.6 M. ) high, growing in rocky or barren soil in North America. 

Description and Properties. — Subglobular, about y% inch (3 Mm.) in 
diameter, drupaceous, crimson, densely hairy, containing a roundish-oblong, smooth 
putamen ; inodorous ; taste acidulous. 

Dose. — The preparations only are used internally. 

Official Preparation. 

Fluidextractum Rhois Glabrae — Fluidextracti Rhois Glabrae — Fluidextract 
of Rhus Glabra. — Dose, \-\ fluidram (1.0-4.0 Cc.) [15 minims (1 Cc), U. S. P.]. 

Physiological Action. — The action of rhus glabra resembles 
that of tannic acid. 

Therapeutics. — Externally and Locally. — An infusion or the 
fluidextract is used as a topical application for ulcers and in- 
flamed wounds. The infusion is an excellent mouth-wash in 
spongy gums, ptyalism, pharyngitis, aphthous stomatitis, and tonsillitis. 
It can be used alone, but is much more efficient when combined 
with potassium chlorate and glycerin, adding a little menthol, 2-3 
grains (0.12-0.20 Gm.), to make the mixture more agreeable. It is 
also of service as an injection in leucorrhea. 

Administration. — The fluidextract is used exclusively. 

Rosa Gallica— Rosae Gallicae— Red Rose. TJ. S. JP. 

Origin. — The dried petals of Rosa gallica L., collected before expanding. 

Description and Properties. — Usually occurring in small cones consisting 
of numerous imbricated, roundish, retuse, deep purple-colored, yellow-clawed petals, 
having a roseate odor and a bitterish, slightly acidulous, and distinctly astringent taste. 

Official Preparations. 

Confectio Rosae — Confectionis Rosae — Confection of Rose. — Used as an 
excipient in pill-masses. 

Fluidextractum Rosae — Fluidextracti Rosae — Fluidextract of Rose. — Used 
chiefly as a vehicle. 



VEGETABLE ASTRINGENTS. 449 

Physiological Action. — It acts like tannic acid. 

Therapeutics. — Externally and Locally. — The ointment is used 
for chapped lips and hands, and also for superficial burns and in 
erythema. 

The fluidextract is used as an application to inflamed eyes, 
buccal, aural, and anal ulcers, and in aphthous stomatitis. It has 
been employed in conjunction with sodium salicylate to prevent 
the pitting of small-pox. Its chief use, however, is as a vehicle 
and flavoring extract. 

Administration. — The fluidextract is mainly used, an infusion 
of which is given internally. The fresh leaves, crushed, are ser- 
viceable as a poultice. 

Rubus— Rubi— Blackberry* U. S. P. 

Origin. — The dried root-bark of the rhizome of Rubus villosus Ait., Rubus nigro- 
baccus Bailey, or of Rubus cuneifolium Pursh., common shrubby North American 
plants. 

Description and Properties. — Thin, tough, flexible bands, outer surface 
blackish or blackish-gray, inner surface pale-brownish, sometimes with strips of whitish, 
tasteless wood adhering ; inodorous ; taste strongly astringent, somewhat bitter. 

Official Preparation. 

Fluidextractum Rubi — Fluidextracti Rubi — Fluidextract of Rubus. — Dose, 
%-2 fluidrams (2.0-8.0 Cc.) [15 minims (1 Cc), U. S. P.]. 

Physiological Action. — Identical with that of tannic acid. 

Therapeutics. — Internally. — The fluidextract is used in the 
summer diarrhea of children — practically its only employment. 
An infusion of the leaves is claimed by Popoff to be an excellent 
remedy for debility of the bladder. 

Administration. — The fluidextract and the infusion are used 
as medicinal agents. The syrupus rubi idaei is used only as a 
vehicle. Blackberry cordial and blackberry brandy are favorite 
modes of administration. It is commonly believed by the laity 
that the various blackberry and raspberry preserves are efficacious 
as remedies in diarrhea ; on the contrary, they are highly irritating, 
because of the seeds present in them. 

29 



ACI DS— ALKALI ES— SALTS. 



SODIUM SALTS. 

Sodium Chloridi— Sodii Chloridi— Sodium Chloride. 

U. 8. JP. 

Sodium chloride, NaCl, although rarely given by way of the 
stomach, save as an emetic, plays such an important role in intrave- 
nous injections for the relief of shock, and is, moreover, so important 
a constituent of the body fluids that it deserves consideration. The 
physical phenomena connected with its absorption and action are 
typical of a class of actions constantly going on in the physiolog- 
ical processes of the body and as such are properly treated in a 
work on Physiology. 1 

Therapeutics. — Local Action. — Weak salt solutions applied to 
the skin penetrate the superficial layers. These become swollen. 
Stronger solutions, by tending to draw water from the tissues, are irri- 
tants — particularly to mucous membranes. Both salt and water may 
be absorbed through mucous membranes ; but neither are taken in 
to any great extent by the skin. On the mucous membrane of the 
mouth, weak (hypotonic solutions) cause a slight swelling of the 
epithelium, while strong solutions are irritant, withdrawing water, 
and often inducing nausea and vomiting. Digestion is not markedly 
affected by small doses — indeed, the effects on taste may be said 
to be helpful to good digestion. 

Internally. — Salt in weak solution is not known to induce 
any marked physiological reactions when taken by the mouth. 
When injected intravenously in strong solutions in animals death 
has been known to occur by reason of its action on the nervous 
system possibly because of its disturbance of water pressure in 
the nerve cells. Death in these cases is usually preceded by 
symptoms of lassitude, increased reflex excitability, and convul- 
sions. Circulation is not known to be affected, save in the late stages. 
Blood changes are usually present. They consist, as a rule, of 
agglutination of the red blood cells with formation of capillary 
thrombi. With isotonic solutions no such results occur. 

Certain effects on the blood are usually present even when the 
salt solution is absorbed through the intestinal walls. Very weak 
solutions bring about a condition of hydremia of the blood, whereas 
a reverse condition may follow the use of comparatively strong 
solutions of salt 1-2 per cent. The various intricacies of the 
reactions of lymph flow and blood flow have little place here, 

1 See Schaefer, Textbook of Physiology. 
450 



ACIDS— ALKALIES-SAL TS. 451 

although of vital importance as biological, if not pharmacological, 
data. 

The action of isotonic salt solution given by the rectum is of 
particular moment, since this is the avenue by which it is most 
frequently introduced. In anemic subjects the solution is absorbed 
with great rapidity, and the volume of the blood, particularly fol- 
lowing its diminution from hemorrhage, rapidly increases. The 
blood-vessels become fuller ; the vascular tone rises, the heart 
action becomes stronger, and bleeding patients at times in a semi- 
comatose condition frequently may be brought out of their lethargy. 

Saline solution thus introduced has a very marked diuretic 
action, particularly if the element of heat be added. The increase 
in the flow of urine is due in large part to the increase in the 
amount of fluid in the vessels, resulting in an increase in tension in 
the capillaries. The chlorides, and the potassium and sodium of 
the urine, are eliminated in larger quantities than are the sulphates, 
phosphates, or urates, but practically all of these are increased in 
amount. 

Tissue metabolism is stimulated by the use of salt, although 
certain investigators have thought that there results from its use a 
slight diminution in proteid catabolism. The general action is, 
however, one of increased lymphatic activity. 

So far as salt baths are concerned, the effects, while they may 
be very beneficial, are not resident in the salt, so far as its absorption 
into the body is concerned. Hygienic, dietetic, and psychothera- 
peutic practices are more to the point in the treatment of patients 
at spas and watering places than the salts contained in the bathing 
water. As an irritant to the skin salt action is beneficial. It tones 
and invigorates the skin and thus, reflexly, the patient in general. 

Salt when taken by the mouth is often very useful. It exerts a 
mild stimulating action on the gastric mucosa, and in combination 
with sulphates and other acids and salts is an essential element in 
all of the mineral waters, which will be discussed later. 

Taken by the rectum (enteroclysis) or by the skin (hypodermo- 
clysis) isotonic salt solutions are invaluable in the treatment of 
collapse conditions due to hemorrhage, to cholera, to dysentery, 
and often to the toxemias of the infectious diseases, notably diph- 
theria, typhoid, and pneumonia. Clinical evidence is certain as to 
the value of isotonic salt in solution for surgical shock, particularly 
when administered hot — Ii2°-ii8° F. As a diuretic in kidney 
affections hot saline enemata are invaluable. 

Liquor Sodii Hydroxidi— Liquoris Sodii Hydroxidi 
—Solution of Sodium Hydroxide. TJ. S. -P. 

(Solution of Sodium Hydrate.) 

Origin. — An aqueous solution containing about 5 per cent, of sodium hydrate, 
NAOH = 39.76. 

Description and Properties. — A clear, colorless liquid, odorless, having a 
very acrid and caustic taste and a strongly alkaline reaction. 

Dose. — 5-20 minims (0.3-1.8 Cc.) [15 minims (iCc), U. S. P.]. 



452 A TEXT-BOOK OF MATERIA MEDIC A. 

Sodii Acetas— Sodii Acetatis— Sodium Acetate. 

TI. S. P. 

Origin. — It may be obtained by neutralizing acetic acid with sodium carbonate, 
The usual article, however, is manufactured on a large scale in the United States in 
the process of purifying acetic acid from wood vinegar. 

Description and Properties. — Colorless, transparent, monoclinic prisms, or 
a granular, crystalline powder, odorless, and having a cooling, saline taste ; efflores- 
cent in warm, dry air. Soluble in 1 1 parts of water and in 23 parts of alcohol ; also 
in 0.5 part of boiling water and in 2 parts of boiling alcohol. Sodium acetate should 
be kept in well-stoppered bottles. 

Dose. — 15-60 grains (1.0-4.0 Gm.) [15 grains (1 Gm.), U. S. P.]. 

Sodii Bicarbonas— Sodii Bicarbonatis— Sodium 
Bicarbonate. 77. S. JP. 

Origin. — Prepared by saturating a mixture of 2 parts of crystallized, and 3 parts 
of dried, sodium carbonate with carbon dioxide, generated by the action of hydro- 
chloric acid upon marble. The damp salt formed is shaken with one-half its weight 
of distilled water, the undissolved portion being dried by exposure to the air. 

Description and Properties. — A white, opaque powder, odorless, and hav- 
ing a cooling, mildly alkaline taste ; permanent in dry, but slowly decomposed in 
moist, air. Soluble in 12 parts of water at 25 C. (77 F. ) ; above that temperature 
the solution loses carbon dioxide, and at a boiling heat the salt is entirely converted 
into normal carbonate. Insoluble in alcohol and ether. The drug should be kept in 
well-closed vessels, in a cool place. 

Dose.— IO-30 grains (0.6-2.0 Gm. [15 grains (1 Gm.), U. S. P.]. 

Official Preparations. 

Mistura Rhei et Sodae — Misturae Rhei et Sodae — Mixture of Rhubarb and 
Soda. — Dose, %-2 fluidounces (7.4-59 Cc.) [1 fluidram (4 Cc), U. S. P.]. 

Trochisci Sodii Bicarbonatis — Trochiscos (ace.) Sodii Bicarbonatis — 
Troches of Sodium Bicarbonate. — Dose, 1 to 6 troches. 

Pulvis Effervescens Compositus — Pulvis Efferve6centis Compositi — Com- 
pound Effervescent Powder (Seidlitz Powder). — Sodium bicarbonate, 31 ; potas- 
sium and sodium tartrate, 93 ; tartaric acid, 27. 

Dose. — Set of 2 powders. To be dissolved in water separately and then com- 
bined and taken while effervescing. 

Sodii Carbonas Monohydratus— Sodii Carbonatis 
Monohydratus— Monohyd rated Sodium Car- 
bonate. V. S. P. 

Origin. — Obtained from sodium sulphate and sodium chloride, but chiefly by a 
•complicated process, known as Leblanc's, from sodium sulphate, which is mixed with 
chalk and coal, the mixture ignited, and the resultant mass exhausted with water and 
concentrated, the carbonate separating from the hot liquid being purified. 

Description and Properties.— Soluble in 2.9 parts of water at 25 C. (77 
F.), in 0.09 part at 38° C. (100.4 F.), in 1.8 parts of boiling water, and in 8 parts of 
glycerin ; insoluble in alcohol and ether. The aqueous solution gives an alkaline 
reaction with litmus-paper, and effervesces strongly with acids. The drug should be 
kept in well-closed vessels. 

Dose. — 2-15 grains (0.0125-1.0 Gm.) [4 grains (0.25 Gm.), U. S. P.]. 

The sodii carbon as contained 10 molecules of water of crystallization or 63 per 
cent. ; part of this was lost on exposure to air, so that the salt was of uncertain 
strength. The sodii carbonas exsiccatus contained about 26 per cent, of water, and 
probably corresponded to the formula Na 2 C0 3 + 2H 2 0. This salt was somewhat- 
hygroscopic. The monohydrated salt does not effloresce at ordinary temperatures, nor 
does it absorb much moisture. It is, therefore, more uniform in composition than either 
of the others. 



A CIDS-ALKALIES—SAL TS. 453 

Sodii Citras— Sodii Citratis— Sodium Citrate. 

U. S. P. 

Description and Properties. — A white, granular powder, odorless, 
2Na 3 C 6 H 5 7 + iiH 2 0. It slowly effloresces on exposure to dry air. Soluble in 1.1 
parts of cold water and in 0.4 part of boiling water ; slightly soluble in alcohol. 

Dose. — Average dose : 15 grains (1 Gm.), U. S. P. 



Sodii Phosphas Exsiccatus— Sodii Phosphatis Ex- 
siccati— Exsiccated Sodium Phosphate. U. S. P. 

Description and Properties. — This is also called anhydrous sodium phos- 
phate, Na 2 HP0 4 ; it is obtained by driving off the water of crystallization of sodium 
phosphate (U. S. P.), which amounts to 60.3 per cent, of the latter's weight. In a 
given weight of the exsiccated salt there are two and a half times as much sodium 
phosphate as in the same weight of the crystallized salt. It is a white powder which 
absorbs moisture readily when exposed to the air and is gradually transformed into a 
salt of the composition Na 2 HP0 4 -j- 7H 2 0, which contains about 47 per cent, of 
water ; the latter salt is permanent. 

Dose.— Average dose: 15 grains (1 Gm.), U. S. P. 

Sodii Phosphas Effervescens— Sodii Phosphatis 
Effervescentis— Effervescent Sodium Phos- 
phate. U. 8. P. 

Description and Properties. — Composed of the exsiccated sodium phos- 
phate, sodium bicarbonate, and tartaric and citric acids. It contains sufficient sodium 
bicarbonate to neutralize the tartaric and citric acids when it is dissolved in water, and 
the carbonic acid gas liberated gives a pleasant acidulous and effervescent taste. 

Dose. — Average dose : 120 grains (8 Gm.), U. S. P. 



POTASSIUM COMPOUNDS. 

Liquor Potassii Hydroxidi— Liquoris Potassii Hy- 
droxidi— Solution of Potassium Hydroxide. 
JJ. S. JP. 

Origin. — An aqueous solution containing about 5 per cent, of potassium hydrate. 

Description and Properties. — A clear, colorless liquid, odorless, having a 
very acrid and caustic taste and a strongly alkaline reaction. It should conform to the 
same reactian and tests as an aqueous solution of potassa. (See Potassa.) 

Dose. — 5-20 minims (0.3-1.2 Cc), well diluted [15 minims (i Cc), U. S. P.]. 



Potassii Acetas— Potassii Acetatis— Potassium 
Acetate. U. S. P. 

Origin. — Prepared by the action of acetic acid upon potassium carbonate. 

Description and Properties. — A white powder or crystalline masses, of a 
satiny lustre, odorless, and having a warm, saline taste ; very deliquescent on exposure 
to the air. Soluble in 0.36 part of water and in 1.9 parts of alcohol; with increasing 
temperature it becomes much more soluble in both liquids. Potassium acetate should 
be kept in well -stoppered bottles. 

Dose. — 15-60 grains (1.0-4.0 Gm.) [30 grains (2 Gm.), U. S. P.]. 



454 A TEXT-BOOK OF MA TERIA MEDICA. 

Potassii Bicarbonas— Potassii Bicarbonatis— 
Potassium Bicarbonate. U. S. I>. 

Origin. — Prepared by the action of carbon dioxide upon a solution of the car- 
bonate. 

Description and Properties. — Colorless, transparent, monoclinic prisms, 
odorless, and having a saline and slightly alkaline taste. Permanent in the air, soluble 
in 3.2 parts of water at 15 C. (59 F. ) and in 1.9 parts at 50 C. (122 F.). At a 
higher temperature the solution rapidly loses carbon dioxide, and, after boiling, con- 
tains only potassium carbonate. It is almost insoluble in alcohol. The drug should 
be kept in well-stoppered bottles. 

Dose. — 10-40 grains (0.6-2.5 Gm.) [30 grains (2 Gm.), U. S. P.]. 

Potassii Bitartras— Potassii Bitartratis— Potassium 
Bitartrate. U. S. JP. 

(Cream of Tartar.) 

Origin. — Prepared by purifying and crystallizing argol or crude tartar, a residuum 
of grape-juice after fermentation. 

Description and Properties. — Colorless or slightly opaque, rhombic crystals, 
or a white, somewhat gritty powder, odorless, and having a pleasant, acidulous taste ; 
permanent in the air. Soluble in about 200 parts of water and in about 16.7 parts of 
boiling water; very slightly soluble in alcohol. 

Dose. — 10 grains to J ounce (0.6-16.0 Gm.) [30 grains (2 Gm.), U. S. P.]. 

Official Preparation. 

Pulvis Jalapae Compositus — Pulveris Jalapae Compositi — Compound Pow- 
der of Jalap. — Dose, 10-30 grains (0.6-2.0 Gm.) [30 grains (2 Gm.), U. S. P.] ; used 
as a hydragogue cathartic. 

Potassii Carbonas— Potassii Carbonatis— Potas- 
sium Carbonate. U. S. JP. 

Origin. — Prepared from the ash obtained from the residue of the beet-sugar man- 
ufacture. It may also be obtained from wood-ashes. 

Description and Properties.— A white, granular powder, odorless, and 
having a strongly alkaline taste; very deliquescent ; soluble in 0.9 part of water at 
25 C. (77 F. ) and in about 0.65 part of boiling water; insoluble in alcohol. Its 
aqueous solution (1:20) has a strongly alkaline reaction upon litmus-paper, and 
effervesces with acids. Potassium carbonate should be kept in well-stoppered bottles. 

Dose.— 5-30 grains (O.3-2.01 Gm.) [10 grains (1 Gm.), U. S. P.]. 

Potassii Citras— Potassii Citratis— Potassium 
Citrate. U. S. P. 

Origin. — Prepared by the action of citric acid upon a solution of potassium 
carbonate. 

Description and Properties. — Transparent, prismatic crystals, or a white, 
granular powder, odorless, and having a cooling, saline taste ; deliquescent on exposure 
to the air. Soluble in 0.5 part of water at 25 C. (77 F.), and very soluble in boiling 
water; feebly soluble in alcohol. Potassium citrate should be kept in well-stoppered 
bottles. 

Dose. — 15-60 grains ( 1.0-4. o Gm.) [15 grains (1 Gm.), U. S. P.]. 

Official Preparations. 

Potassii Citras Effervescens — Effervescent Potassium Citrate. — Potassium 
citrate, 200 ; sodium carbonate, 477; tartaric acid, 252; citric acid, 162. 
Dose, 7-45 grains (0.5-3.0 Gm.). 






A CIDS— ALKALIES— SAL TS. 455 

Liquor Potassii Citratis — Solution of Potassium Citrate. — An aqueous liquid 
containing not less than 8 per cent, of anhydrous potassium citrate. To be made freshly 
when wanted. 

Dose, J-I ounce (15-30 Cc.) [4 drams (16 Cc), U. S. P.]. 

PREPARATIONS OF CALCIUM. 

Calcii Carbonas Praecipitatus— Calcii Carbonatis 
Praecipitati— Precipitated Calcium Carbonate. 
V. S. JP. 

Origin. — Prepared by mixing aqueous solutions of calcium chloride and sodium 
carbonate, the resulting precipitate of calcium carbonate being purified. 

Description and Properties. — A fine white powder, without odor or taste, 
permanent in the air. Nearly insoluble in water, its solubility being increased by the 
presence of ammonium salts, and especially by carbonic acid, and diminished by alkali 
hydrates. Insoluble in alcohol, but in diluted acetic, hydrochloric, or nitric acid com- 
pletely soluble, with effervescence. 

Dose. — 15-30 grains (1.0-2.0 Gm.) [15 grains (i Gm.), U. S. P.]. 

Creta Praeparata— Cretae Praeparatae— Prepared 
Chalk. U. 8. JP. 

Origin. — Native calcium carbonate, freed from most impurities by elutriation. 

Description and Properties. — A white, amorphous powder, often molded 
into conical drops, odorless and tasteless, permanent in the air. Almost insoluble in 
water ; insoluble in alcohol ; soluble in diluted acetic, hydrochloric, or nitric acid, with 
copious effervescence, but without leaving more than a trifling residue. 

Dose. — 5-60 grains (0.3-4.0 Gm.) [15 grains (1 Gm.), U. S. P.J. 

Official Preparations. 

Hydrargyrum cum Creta — Hydrargyri cum Creta — Mercury with Chalk. — 
Dose, 2-10 grains (0.12-0.6 Gm.) [4 grains (0.25 Gm.), U. S. P.]. (Described under 
Hydrargyrum . ) 

Pulvis Cretae Compositus — Pulveris Cretae Compositi — Compound Chalk 
Powder. — Dose, 20-60 grains (1.30-4.0 Gm.) [30 grains (2 Gm.), U. S. P.]. 

Liquor Calcis— Liquoris Calcis— Solution of Calcium 
Hydroxide. TJ. S. J*. 

(Solution of Calcium Hydroxide ; Lime Water.) 

Origin. — A saturated aqueous solution which should contain not less tnan 0.14 
per cent, of pure calcium hydroxide. 

Description and Properties. — A clear, colorless liquid, without odor, and 
having a saline and feebly caustic taste. It absorbs carbon dioxide from the air, so that 
a pellicle of calcium carbonate forms on the surface of the liquid. On being heated it 
becomes turbid through separation of calcium hydrate, which redissolves when the 
liquid is cooled. It gives a strong alkaline reaction with litmus-paper. 

Dose. — X~4 ounces ( 1 5.0-1 18.3 Cc.) [4 fluidrams (16 Cc), U. S. P.]. 

Official Preparations. 

Linimentum Calcis — Linimenti Calcis — Lime Liniment (Carron Oil). — 
Equal parts of lime-water and linseed oil. For external use. 

Mistura Cretae — Misturae Cretae — Chalk Mixture. Compound chalk powder, 
cinnamon water, and water. 

Dose, 1-4 fluidrams (4.0-15.0 Cc.) [4 drams (16 Cc. ), U. S. P.]. 

Syrupus Calcis — Syrupi Calcis — Syrup of Lime. — Dose, \-2 fluidrams (1.8- 
7.4 Cc.) [30 minims (2 Cc), U. S. P.]. 



456 A TEXT-BOOK OF MATERIA MEDICA. 



PREPARATIONS OF LITHIUM, 

Lithii Carbonas— Lithii Carbonatis— Lithium 
Carbonate. U. S. jP. 

Origin, — Lithium is found in many mineral waters, the carbonate being prepared 
from lepidolite. 

Description and Properties. — A light, white powder, odorless, and having 
an alkaline taste ; permanent in the air. Soluble in 75 parts of water and 140 parts of 
boiling water ; much more soluble in water saturated with carbon dioxide ; insoluble in 
alcohol, but soluble in diluted acids, with active effervescence. 

Dose. — 2-10 grains (0.12-0.6 Gm.) [7 J grains (0.5 Gm.), U. S. P.]. 



Lithii Citras— Lithii Citratis— Lithium Citrate. 

U. S. JP. 

Origin. — Prepared by adding lithium carbonate to a solution of citric acid. 

Description and Properties. — A white powder, odorless, and having a cool- 
ing faintly alkaline taste ; deliquescent on exposure to the air. Soluble in 2 parts of 
water and in 1.5 parts of boiling water ; almost insoluble in alcohol and ether. Lithium 
citrate should be kept in well-stoppered bottles. 

Dose. — 2-10 grains (0.12-0.6 Gm.) [7^ grains (0.5 Gm.), U. S. P.]. 

Official Preparation. 

Lithii Citras Effervescens — Lithii Citratis Effervescentis — Effervescent 
Lithium Citrate. — Dose, 1-2 drams (4.0-8.0 Gm. ) [2 drams (8 Gm.),U. S. P.]. 



PREPARATIONS OF MAGNESIUM. 
Magnesii Oxidum— Magnesii Oxidi— Magnesia. 

(Light Magnesia; Calcined Magnesia.) 

Origin. — Prepared by subjecting magnesium carbonate to a low red heat in a Cor- 
nish or Hessian crucible closed loosely by a lid. 

Description and Properties.— A white, very light, and very fine powder, 
without odor, and having an earthy, but not a saline, taste. On exposure to the 
air it slowly absorbs moisture and carbon dioxide. Almost insoluble in water and 
insoluble in alcohol, but soluble in diluted acids. Magnesia should be kept in well- 
closed vessels. 

Dose. — As an antacid, 10-15 grains (0.6-1.0 Gm.) [30 grains (2 Gm.), U. S. P.]. 

Magrnesii Oxidum Ponderosum— Magnesii Oxidi 
Ponderosi— Heavy Magnesia. U. S. P. 

(Heavy Magnf.sia.) 

A white, dense, and very fine powder, which should conform to the reactions and 
tests for magnesia, from which it differs in not readily uniting with water to form a 
gelatinous hydrate. 

Official Preparation. 

Pulvis Rhei Compositum Pulveris Rhei Compositi — Compound Powder 
of Rhubarb. — Formula: Rhubarb, 25; magnesia, 65; finger, 10 parts. 

Dose. — As a laxative, 20-60 grains ( 1 30-4.0 Gm. ) [30 grains (2 Gm.). U. S. P ]. 



ACIDS— ALKALIES—SAL TS. 457 

Magnesii Carbonas— Magnesii Carbonatis— 
Magnesium Carbonate. U. s. P. 

Origin.— Prepared by evaporating to dryness the mixed solutions of magnesium 
sulphate and sodium carbonate, and purifying and drying the residue. 

Description and Properties.— Light, white, friable masses^ or a light, white 
powder, without odor, and having a slightly earthy taste; permanent in the air. 
Almost insoluble in water, to which, however, it imparts a slightly alkaline reaction • 
insoluble in alcohol, but soluble in diluted acids, with active effervescence. 

Dose.— As an antacid, 5-20 grains (0.3-1.3 Gm.) [44 grains (3 Gm.), U. S. P.]. 

Official Preparation. 

Liquor Magnesii Citratis— Liquoris Magnesii Citratis— Solution of Magne- 
sium Citrate. — A liquid of magnesium carbonate, citric acid, and potassium bicarbonate, 
widely used as a pleasant laxative. 

Dose. — 2-12 ounces (60-360 Cc). 

Magnesii Sulphas— Magnesii Suiphatis— Magne- 
sium Sulphate. 

See Cathartics. 

PREPARATIONS OF AMMONIUM. 

Ammonii Carbonas— Ammonii Carbonatis— 
Ammonium Carbonate. U. S. JP. 

Origin. — Prepared by a complicated process by heating in an iron or earthen 
retort a mixture of sal ammoniac and chalk. 

Description and Properties. — White, hard, translucent, striated masses 
having a strongly ammoniacal odor without empyreuma, and a sharp, saline taste. 
On exposure to the air the salt loses both ammonia and carbonic acid, becoming 
opaque, and is finally converted into friable porous lumps or a white powder. Slowly 
but completely soluble in about 5 parts of water at 15 C. (59 F.), and decomposed 
by hot water, with the evolution of carbonic acid and ammonia. By prolonged boil- 
ing with water the salt is completely dissipated. The aqueous solution possesses a 
strongly alkaline reaction and effervesces with acids. 

Dose. — 3-10 grains (0.1S-0.6 Gm.). 

Official Preparation. 

Spiritus Ammoniae Aromaticus — Spiritus Ammonise Aromatici — Aromatic 
Spirit of Ammonia. — Composition : Ammonium carbonate, ammonia water, aromatic 
oils, alcohol, and water. 

Description and Properties. — A nearly colorless liquid when freshly prepared, but 
gradually acquiring a somewhat darker tint. It has a pungent, ammoniacal odor and 
taste. 

Dose. — £-1 fluidram (1.8-3.7 Cc.) [30 minims (2 Cc), U. S. P.]. 

Antagonists and Incompatibles. — The alkalies and their car- 
bonates are incompatible with acids and with metallic salts. The 
ammonium carbonate is incompatible with the acidulous salts and 
with lime water. 

Physiological Action. — The alkalies mentioned in this group 
may be divided into direct antacids, or those which neutralize or 
lessen the acidity of the stomach, and indirect antacids, or those 
which, being oxidized in the blood, are excreted as carbonates, 



458 A TEXT-BOOK OF MATERIA MEDIC A. 

diminishing the acidity of the urine and increasing the alkalinity of 
the blood, although not influencing the acidity in the stomach. 

The direct antacids are lime water, prepared chalk, and magnesia. 

The indirect antacids are potassium acetate, bitartrate, citrate, 
and tartrate, sodium acetate, and lithium citrate. 

The following alkalies are both direct and indirect antacids : 
solution of potassa, solution of soda, carbonates and bicarbonates 
of potassium, sodium, lithium, magnesium, and ammonium. 

The physiological action of the various alkalies will now be con- 
sidered in detail. 

Externally and Locally. — The hydrates of potassium and sodium 
are caustic and rubefacient. The solutions of soda and potassa, 
when applied undiluted, irritate the surface of the skin and soften 
and dissolve the epidermis and horny tissues, uniting with the 
albumin of the various structures to form a soluble alkali-albu- 
minate. The carbonates and bicarbonates exert a similar, though 
much weaker, action, while the acetates, bitartrates, citrates, and 
tartrates have no local influence. 

The ammonium salts do not affect the epidermis in the manner 
of those previously mentioned, penetrating without dissolving it, 
irritating the underlying structures, and inducing an effusion of 
lymph, thus acting as vesicants. Should a strong solution of 
ammonia be applied to the skin and evaporation be prevented, 
suppuration and sloughing may ensue. 

Internally. — Digestive System. — Potassium salts in small doses 
promote the secretion of gastric juice. Large doses neutralize free 
acid in the stomach, and, by rendering the chyme neutral or alka- 
line, interefere with the secretion from the pancreas, liver, and 
intestines, thereby deranging digestion. 

The statement that alkaline carbonates given before a meal 
increase the secretion of gastric juice seems to rest more on clinical 
interpretation than on experimental evidence, for lower animals, at 
least. The so-called " law of contraries," taught for so many years, 
has little foundation in experimental work. The therapeutic results 
sometimes obtained must be explained on other grounds. 

Circidatory System. — The alkaline salts of potassium, by lessen- 
ing the acidity of the gastric juice and entering the circulation, 
increase the alkalinity of the blood. The bicarbonates, however, 
taken in large doses upon an empty stomach, enter the circulation 
unchanged, where, by decomposing the neutral phosphate of 
sodium present, they form the acid phosphate of sodium, reducing 
the alkalinity of the blood and increasing the acidity of the urine. 

The acetates, citrates, and bitartrates enter the blood unchanged. 
The acid radical being destroyed, and the base combining with the 
carbon dioxide formed, the salts are converted into the alkaline car- 
bonates, increasing the alkalinity of the blood and urine. 

Should the caustic alkalies be injected directly into the blood, 
death quickly ensues from coagulation of that fluid, arising from 
excessive formation of alkali-albuminate. Under very large or 



ACIDS— ALKALIES—SAL TS. 459 

poisonous doses the heart-muscle is weakened, decreasing the force 
of its contractions, arrest taking place in diastole. Even medicinal 
doses, if long continued, may occasion cardiac depression, diminish- 
ing the force of the circulation. Small doses may increase blood- 
pressure, though the pulse-rate be diminished. Minute amounts of 
potassium salts applied to muscle diminish or paralyze its contractile 
power. 

Nervous System. — When potassium salts are administered in 
medicinical doses and for a reasonable length of time, no important 
action upon the nervous system is produced ; but if excessive doses 
be taken, the nerve-centers and motor nerves are paralyzed, after a 
period of temporary excitement. Owing, however, to the fact that 
potassium is a protoplasmic poison, affecting alike the muscles and 
nerve-tissues, its salts should not be given in full doses for too long 
a period without counteracting their depressing influence by the use 
of muscle and nerve-tonics. 

Respiratory System. — The only action of importance upon the 
respiratory system is the increased amount and diminished viscidity 
of the secretion from the bronchial tubes. 

Absorption and Elimination. — The potassium salts possess very 
high diffusive power. They are easily and quickly absorbed and 
rapidly excreted, the salts with vegetable acids being eliminated as 
alkaline carbonates, rendering the urine alkaline. Salts of potassium 
are chiefly eliminated by the kidneys, though the process takes place 
to some extent through the bronchial mucous membrane and other 
secretions. They are active diuretics, increasing the amount of 
water and, by stimulating the renal epithelium, augmenting the 
excretion of solids. The uric acid is greatly diminished, being con- 
verted into urea, and as such eliminated, showing that the alkalies 
increase oxidation and promote catabolism. 

Temperature. — Medicinal doses have no effect upon temperature. 

Untoward Action. — Under prolonged dosage the digestion be- 
comes impaired. There is present paralysis of the muscular fibers 
of the intestines, accompanied by diarrhea or constipation and tym- 
panities. There may be also present emaciation, muscular weakness, 
nervous prostration, and anemia. 

Poisoning. — The caustic preparations of sodium and potassium 
produce the symptoms of the corrosive poisons, resembling the 
poisonous action of the mineral acids to be described. Death 
is occasionally preceded by convulsions, the heart's action being 
arrested before respiratory failure. The carbonates and bicarbonates 
and the salts of vegetable acids are not considered poisonous, nor 
do they produce the corrosive effects of caustic potash or its solution. 

Treatment of Poisoning. — Vegetable acids are chemically incom- 
patible, and should be given freely, together with oils and demul- 
cent drinks as protectives, and opium, if necessary, to relieve pain. 
Cardiac stimulants — digitalis, brandy, caffeine, etc. — may be required 
to sustain the heart, to be given hypodermically. 

The Comparative Action of the Alkalies. — Sodium salts in 



460 A TEXT-BOOK OF MATERIA MEDICA. 

their action are analogous to potassium, although less irritating 
to the gastro-intestinal tract. They are also less depressing to the 
circulatory, muscular, and nervous systems. 

Lithium salts closely resemble in their effects those of potas- 
sium, their action upon the nerves and muscles, however, being 
less powerful. The contractile force of muscle is invariably di- 
minished by lithium and increased by potassium. They are useless 
as lithium in gout. The large amount of water with which they are 
usually given is the most potent factor in lithium " gout " cures. 

Calcium salts are more sedative and astringent in their action 
upon the gastro-intestinal tract than the other alkalies, and are 
direct antacids. They tend to produce constipation. The nervous 
and muscular systems are less affected by these salts than by the 
remaining alkalies, the contractile muscular force, however, being 
increased by calcium. They are less readily absorbed and excreted 
than the foregoing alkalies, and less active in increasing the alka- 
linity of the urine. They are useful heart stimulants. 

Magnesium Salts. — Magnesia and the magnesium carbonates 
are direct antacids and sedatives to the stomach, acting upon the 
intestinal canal as saline cathartics. In their influence upon the 
circulatory system they are feebler than, but similar to, the potas- 
sium salts, slightly increasing the alkalinity of the blood. They 
are not so readily absorbed, nor so rapidly excreted, as the salts 
of potassium and sodium, while increasing the amount of water and 
solids excreted. 

Ammonium Salts. — These preparations are used rather as car- 
diac stimulants, their physiological action being more extensively 
considered under that group. As antacids their action may be 
briefly compared with that of the other alkalies. Their effect upon 
the gastric juice and its secretion is similar to that of the carbonates 
and bicarbonates already mentioned. They dilate the blood-vessels 
of the stomach, augmenting the blood-supply and producing a sen- 
sation of warmth in the epigastrium. Lethal doses act as emetics. 
They increase the glycogenic function of the liver and stimulate the 
circulatory system, elevating the pulse-rate and raising arterial 
tension. In medicinal doses they stimulate the spinal cord, motor 
nerves, and muscles, while toxic doses paralyze these structures. 
They prevent the coagulation of the blood and lessen the oxygen- 
carrying power of the red corpuscles. By them also the respirations 
are increased in frequency. 

The salts of ammonium are quickly absorbed and undergo oxi- 
dation in the body, augmenting the amount of uric acid and urea in 
the urine, thereby increasing its acidity to some extent. 

As regards the poisonous activity of the alkalies mentioned, 
ammonium ranks, next to potassium, the most toxic of all. 

Therapeutics. — Externally and Locally. — Norton has recom- 
mended liquor potass.ic in ingrowing toenail, the solution being 
applied to the nail, which is soon rendered so soft that it can be easily 
scraped without causing pain. The same remedy is used in many 



ACIDS— ALKALIES—SAL TS. 461 

diseases of the skin to allay itching and soften the horny epithelium. 
It is also employed extensively in diseases of the ear and throat, and 
in the proportion of 1 part to 10 parts of water it is very effective in 
softening impacted cerumen. 

The potassium carbonate in solution is frequently used in various 
pruriginous diseases of the skin, being a highly efficient antipruritic. 

The detergent and sialagogue properties of potassium citrate . 
and tartrate are rendered serviceable in certain diseases of the 
mouth. 

Sodium bicarbonate is a deservedly popular dressing for burns, 
and pain and swelling of the joints in acute articular rheumatism are 
sometimes greatly relieved by enveloping the articulations in a hot 
solution rendered alkaline with this salt. In diseases of the ear it is 
used for the same purposes as the potassium preparations above 
mentioned. It is one of the ingredients of " Dobell's Solution," 
which is an effective antiseptic wash in nasal catarrh, and the solu- 
tion of sodium bicarbonate has been suggested as a valuable remedy 
in thrush or aphtlice. 

Sodium carbonate may be used for the same purposes as the 
bicarbonate, though probably inferior to it in all cases save infantile 
eczema capitis, in which condition it is a most valuable remedy for 
softening the eczematous crusts. 

Prepared chalk is an ingredient of many ointments used in the 
treatment of erysipelas and subacute eczema. Lime water, mixed 
with equal parts of linseed or olive oil, is highly prized as a dress- 
ing for burns, and the efficiency of the " black " and " yellow " 
washes in the treatment of veneral sores is too well known to 
require further testimony in their favor. These calcium preparations 
also make excellent applications in acute eczema. Lime water may 
sometimes be used with advantage in leukorrhea and vaginitis. 

Magnesium carbonate makes an efficient dusting powder in der- 
matitis and irritable conditions of the skin. Ammonium carbonate 
mixed with lanolin readily dissolves the epidermic scales of psori- 
asis, and the aromatic spirit of ammonia is a grateful application 
to the scalp in pityriasis. 

Internally. — Digestive System. — The carbonates and bicarbon- 
ates, when given before meals, serve to increase the flow of gastric 
juice. They act as sedatives to the stomach, particularly in painful 
conditions arising from a deficient secretion of gastric juice. As 
antacids, when given after meals, they are very useful in counter- 
acting excessive acidity of the stomach. The acidity due to the 
formation of fatty acids, the result of defective digestion, is not 
relieved by the administration of these salts after meals, but if taken 
before meals they are valuable in correcting the deficiency of gastric 
secretion, to which the disordered digestion is due. In atonic 
dyspepsia these preparations administered with vegetable bitters 
serve a useful purpose. 

The bicarbonates and the salts of the vegetable acids are of 
some value in gout, possibly from changes in the composition of 



462 A TEXT-BOOK OF MATERIA MEDIC A. 

the blood, possibly by reason of the copious diuresis set up by the 
water and salt action. They are also of benefit occasionally in the 
treatment of acute rheumatism. Butler is of the opinion that in the 
treatment of acute rheumatic arthritis alkalies are far superior to 
any other drugs, salicylic acid not excepted. 

While it is admitted that the treatment of acute rheumatism by 
alkalies alone will not shorten the course of the disease so readily 
as the employment of salicylates, he believes there is certainly less 
danger of heart-complications, the period of convalescence is 
reduced, and the tendency to relapse lessened by the use of 
alkaline remedies. 

The acetates, bitartrates, and citrates are efficient diuretics, 
cathartics, and diaphoretics, the first-named salts being superior 
diuretics, the potassium bitartrate a reliable cathartic, and the 
citrates active diaphoretics. 

In chronic Bright s disease the acetates and citrates are frequently 
indicated for their diuretic action, while potassium bitartrate is 
one of the most effective cathartics and diuretics in acute nephritis 
and cardiac dropsy. 

Lime water is a useful remedy for vomiting — whether due to 
irritability, gastic ulcer, or cancer — and is also valuable in checking 
this symptom in pulmonary tuberculosis. It is an important adjunct 
to milk, in preventing the formation of curds and relieving infantile 
vomiting. 

In the acute mycotic diarrhea of children, characterized by acid 
gastro-intestinal fermentation, the lime water is extremely useful. 
The symptoms also of chronic diarrhea and dysentery are often 
mitigated by this simple remedy. 

Lime water is without doubt a very efficient remedy in diabetes 
insipidus, and may also exert a favorable influence in chronic bron- 
chitis by checking and otherwise modifying the mucous secretion. 
It should be remembered that this preparation is a valuable anti- 
dote in arsenical poisoning. The syrup of lime is a very inferior 
remedy, the sugar which it contains neutralizing the beneficial 
action which the lime alone might exert. 

Prepared chalk, or chalk mixture, is useful in relieving the 
premonitory diarrhea of cholera, and simple diarrheas of children, 
with greenish acid stools and flatulent distention of the abdomen, 
are greatly benefited by this preparation. It is very necessary, 
however, that the chalk mixture be freshly prepared, the cinnamon 
water it contains being liable with age to fungoid contamination, 
and the propagation of micro-organisms, which might seriously 
aggravate the condition for which the remedy is given, occasioning 
vomiting etc. This old standby is being superseded, however, in 
later-day pediatrics by the use of mild salines and intestinal anti- 
septics. Chalk mixture is still useful, however, in diarrheas not due 
to bacterial causes. 

Magnesia is an invaluble antacid in gastric disorders, and espe- 
cially in aphtha attending infantile diarrhea. 



ACIDS— ALKALIES— SALTS. 463 

The ammonium preparations are useful antacids, being particu- 
larly efficacious in the dyspepsia of drunkards to allay nausea and 
vomiting, render the mucus less viscid, and act as stimulants to the 
circulation. Their excitant qualities, together with their property 
of modifying the mucous secretion, render them also of value in 
appropriate cases of subacute and chronic bronchitis. In cardiac 
therapy the ammonium compounds are valuable as quick diffusible 
stimulants. 

In conclusion, it may be well to mention the values of alkalies 
in aiding the digestio7i of fats, and as efficient remedies in the dys- 
pepsia and indigestion from which obese, gouty, and rheumatic 
subjects frequently suffer. 

The virtue and uses of mineral waters will be fully discussed in 
the group devoted to the subject. The use of many of the alkaline 
salines is further discussed under the heading Cathartics. 

Administration. — The alkalies should invariably be adminis- 
tered largely diluted, thus favoring absorption and preventing their 
irritant action upon the gastro-intestinal mucous membrane. The 
time of administration — whether before or after meals — will depend 
entirely upon the effect desired, a thorough knowledge of their 
action as above given being necessary to an intelligent and proper 
use of the various preparations. 



NITRATES. 

Potassii Nitras— Potassii Nitratis— Potassium 
Nitrate. U. S. J>. 

(Nitre; Saltpetre.) 

Origin. — Purified from native saltpetre. 

Description and Properties. — Colorless, six-sided, rhombic prisms, or a 
crystalline powder ; odorless, and having a cooling, saline, and pungent taste. Per- 
manent in the air. Soluble in 3.6 parts of water, very sparingly soluble in alcohol. 

Dose. — 5-30 grains (0.3-2.0 Gm.) [7^ grains (0.5 Gm). U. S. P.]. 

The action of the nitrates is, in the main, like the salts. There 
is thought to be a distinct nitrate ion action. 

Physiological Action. — Externally and Locally. — The taste is 
cool and salty and the nitrates increase the flow of saliva. 

Internally. — Digestive System. — Large doses occasion nausea and 
vomiting ; poisonous doses produce violent gastro-intestinal inflam- 
mation and diarrhea, blood sometimes being vomited and passed 
with the stools. 

Nervous System. — No special action is noticeable, although poi- 
sonous doses produce tremulousness, insensibility, and convulsions. 

Circulatory System. — Small doses have no marked influence on 
the circulatory system ; full doses act as a cardiac depressant, slow- 
ing and weakening the pulse ; poisonous doses produce great weak- 



464 A TEXT-BOOK OF MATERIA MEDICA. 

ness, syncope, and death from cardiac failure. These results are 
possibly due to the action of the potassium ion. 

Respiratory System. — Large doses retard respiration. 

Absorption and Elimination. — Potassium nitrate passes rapidly 
into the blood unchanged, and is eliminated by the kidneys un- 
changed. Small doses are actively diuretic, stimulating the renal 
cells. Large amounts, from too free stimulation, are apt to irritate 
and inflame the kidneys, even so far as to produce hematuria. The 
drug is also eliminated to some extent by the skin, being therefore 
a mild diaphoretic. 

Temperature. — Unaffected by medicinal amounts, but lowered 
by poisonous doses. 

Poisoning. — There is violent gastro-intestinal inflammation, with 
vomiting and purging, blood being present in the ejecta and feces. 
Other symptoms are — subnormal temperature, coldness of the ex- 
tremities, a weak and thready pulse, slow and shallow respiration, 
tremulousness and great muscular weakness, dimness of vision or 
total blindness, deafness, insensibility, and possibly convulsions. 
The urine is diminished or supressed. 

Should the patient recover from an immoderate dose of the drug, 
he suffers for some time from dysuria, irritability of the stomach, 
colic, muscular weakness, and a sensation of chilliness in the back 
and limbs. 

Treatment of Poisoning. — There is no special antidote for nitre ; 
cases of poisoning, therefore, are to be treated symptomatically, 
measures for relief including evacuation of the stomach, demulcents, 
opiates for pain, and cardiac and respiratory stimulants. 

Therapeutics. — Externally and Locally. — Solutions of this drug 
have been found serviceable as applications to bruises and abrasions. 
The last stage of pharyngitis is greatly relieved by a gargle of a 
solution of potassium nitrate, in the proportion of 1 dram 
(4.0 Gm.) to 1 pint (473 Cc.) of water. 

It is claimed that a paste of powdered nitre and water applied 
to the face night and morning is an effective method of removing 
freckles. Suffice it to say it is not a panacea. 

The difficulty of breathing in cases of spasmodic asthma may be 
at times relieved by the inhalation of the fumes of burning nitre- 
paper. 

Internally. — The drug was formerly much used in acute artic- 
ular rheumatism and as a refrigerant and sedative in inflammations , 
pneumonia, and various fevers. It is employed to a considerable 
extent as a diuretic and diaphoretic, although greatly inferior to the 
acetates and citrates. 

Administration. — It should be given in solution, though the 
powder is sometimes used in combination with calomel, tartar 
emetic, or Dover's powder. 

The potassium-nitrate paper, as has been stated, should be 
burned and the fumes arising therefrom inhaled. 



A CIDS— ALKALIES— SAL TS. 465 

Sodii Nitras— Sodii Nitratis— Sodium Nitrate. 

77. 8. JP. 

Origin. — It is found in great quantities imbedded in clay and sand in certain 
districts of Chili and Peru. 

Description and Properties.— Colorless, transparent, rhombohedral crystals, 
odorless, having a cooling, saline, and slightly bitter taste ; deliquescent in moist air. 
Soluble in 1.3 parts of water and in about 100 parts of alcohol. Sodium nitrate should 
be kept in well -stoppered bottles. 

Dose.— }i-i ounce (15. 5-31.0 Gm.) [15 grains (1 Gm.), U. S. P.]. 

Physiological Action. — The action of the salt resembles closely 
that of potassium nitrate, though it is much feebler than the latter 
drug, particularly being less depressing to the heart muscle and in 
possessing greater purgative properties. 

Therapeutics. — Externally and Locally. — A solution of the salt 
possesses some power as a solvent of false membranes, and has 
been used in the form of a spray to diminish fibrinous exudations 
in the pharynx and larynx. 

Internally. — It may be employed for the same purpose as the 
potassium nitrate and has been advantageously adopted as a laxa- 
tive in diarrhea and dysentery. 

Administration. — Sodium nitrate is best given dissolved in a 
large quantity of water. 



IODINE AND THE IODIDES. 
Iodum— Iodi— Iodine. 77. S. I*. 

Origin. — It is found in the ashes of sea-weeds, and is prepared from the mother 
liquor obtained in the purification of Chili saltpetre. 

Description and Properties. — Heavy, bluish-black, dry and friable, rhombic 
plates, having a metallic luster, a distinctive odor, and a sharp and acrid taste. It 
imparts a deep-brown, slowly evanescing stain to the skin, and gradually destroys 
vegetable colors. Iodine is soluble in about 5000 parts of water and in 10 parts of 
alcohol, with a brown color ; also freely soluble in ether and in a solution of potassium 
iodide, with a brown color, and in chloroform or carbon disulphide, with a violet color. 
It should be kept in glass-stoppered bottles, in a cool place, 

Dose. — About % grain (0.016 Gm. ) [^ grain (0.005 Gm.), U. S. P.], although 
seldom given in substance. 

Official Preparations. 

Liquor Iodi Compositus — Liquoris Iodi Compositi — Compound Solution 
of Iodine (Lugol's Solution). — Iodine, 5; potassium iodide, 10; distilled water, 
to make 1 00 parts. Strength, 5 per cent. 

Dose. — 1-10 minims (0.06-0.6 Cc. ) [3 minims (0.2 Cc), U. S. P.]. 

Tinctura Iodi— Tincturse Iodi — Tincture of Iodine. — Iodine, 70 ; alcohol, 
to 1000. Strength, 7 per cent. 

Dose. — 1-5 minims (0.06-0.03 Cc.) [l}4 minims (0.1 Cc. ), U. S. P.]. 

Unguentum Iodi — Ungunti Iodi — Iodine Ointment. — Iodine, 4 ; potassium 
iodide, 4 ; glycerin, 12 ; benzoinated lard, S3. Strength, 4 per cent. For external 



30 



466 A TEXT-BOOK OF MA TERIA MEDICA. 

Acidum Hydriodicum Dilutum— Acidi Hydriodici 
Diluti— Diluted Hydriodic Acid. U. 8. J>. 

Definition. — A solution of hydriodic acid, HI, containing not less than io per 
cent, by weight of the absolute acid, and about 90 per cent, of water. 

Description and Properties. — A clear, colorless liquid, odorless, and having 
an acid taste. It should not become colored on keeping. Miscible in all proportions 
with water or alcohol. In the present preparation there is a small quantity of hypo- 
phosphorous acid. This acts as a preservative by reducing any iodine set free to 
hydriodic acid. The method of preparing it (for which see the Pharmacopoeia) is that 
recommended in the 1890 U. S. Pharmacopoeia in connection with the preparation of 
Syrupus Acidi Hydriodici ; the latter is now prepared from the Acidum Hydriodicum 
Dilutum. The method is simple and requires no special apparatus or chemicals 
(Hunt). 

Dose. — Average dose : 8 minims (0.5 Cc), U. S. P. 

Caution. — Should be kept in small, amber-colored, glass-stoppered bottles, 
protected from the light. 

Syrupus Acidi Hydriodidi— Syrupi Acidi Hydriodidi 
—Syrup of Hydriodic Acid. U. 8. JP. 

A syrupy liquid containing about I per cent, by weight of absolute hydriodic acid. 
Description and Properties. — A transparent, colorless, or only pale-straw- 
colored liquid, odorless, and having a sweet and acidulous taste. 

Dose.— y z -2. fluidrams (2.0-8.0 Cc.) [1 dram (4 Cc), U. S. P.]. 

Ammonii Iodidum— Ammonii Iodidi— Ammonium 
Iodide. U. 8. JP. 

Origin. — It is prepared by dissolving potassium iodide and ammonium sulphate 
in boiling water, adding alcohol, filtering, washing the filtrate, and evaporating it to 
dryness. 

Description and Properties. — Minute, colorless, cubical crystals, or a white, 
granular powder, without odor when colorless, but emitting a slight odor when colored, 
and having a sharp, saline taste. The salt is hygroscopic, and soon becomes yellow, 
or yellowish-brown, on exposure to the air and light, owing to the loss of ammonia and 
the elimination of iodine. Soluble in 0.6 part of water and in 9 parts of alcohol. 
Ammonium iodide should be kept in small, well-stoppered vials, protected from light. 

Dose. — 3-20 grains (0.18-1.2 Gm. ) [4 grains (0.25 Gm.), U. S. P.]. 

Potassii Iodidum— Potassii Iodidi— Potassium 
Iodide. V. 8. JP. 

Origin. — Iodine is dissolved in a solution of potassa in hot distilled water. 
The solution is evaporated, and the residue heated with charcoal. Dissolve in boiling 
water, filter, wash the filtrate, and crystallize. 

Description and Properties. — Colorless, transparent or translucent, cubical 
crystals, or a white, granular powder, having a peculiar, faint, iodine-like odor, and a 
pungent, saline, and afterward bitter taste. Permanent in dry air and but slightly 
deliquescent in moist air. Soluble in 0.7 part of water and in 12 parts of alcohol ; 
also soluble in 2.5 parts of glycerin. Potassium iodide should be kept in well- 
stoppered bottles. 

Dose. — 2-30 grains (0.12-2.0 Gm.) [7^ grains (0.5 Gm.), U. S. P.]. 

Official Preparation. 

Unguentum Potassii Iodidi — Unguenti Potassii Iodidi— Ointment of Potas- 
sium Iodide. — Potassium iodide, io ; potassium carbonate, 0.6 ; water, 10 ; benzoinated 
lard. 88. For external use. 



A CIDS— ALKALIES— SAL TS. 4&7 

Sodii Iodidum— Sodii Iodidi— Sodium Iodide. 

U. 8. JP. 

Origin. — Prepared from a solution of soda in a manner similar to the preparation 
of potassium iodide. 

Description and Properties. — Colorless, cubical crystals, or a white, crys- 
talline powder, odorless, and having a saline and slightly bitter taste. In moist air it 
deliquesces and becomes partially decomposed into sodium carbonate and free iodine, 
assuming thereby a reddish color. Soluble in 0.5 part of water and in about 3 parts 
of alcohol. It should be kept in well-stoppered bottles. 

Dose. — 2-30 grains (0.12-2.0 Gm.) [7% grains (0.5 Gm.), U. S. P.]. 

Strontii Iodidum— Strontii Iodidi— Strontium Iodide. 

U. 8. JP. 

Origin. — Prepared by neutralizing freshly prepared solution of hydriodic acid 
with strontium carbonate, concentrating the filtrate, and crystallizing. 

Description and Properties. — Colorless, transparent, hexagonal plates, 
odorless, and having a bitterish, saline taste ; deliquescent and colored yellow by 
exposure to air and light. Soluble in 0.5 part of water, also soluble in alcohol, 
and slightly in ether. It should be kept in dark, amber-colored, glass- stoppered vials. 

Dose. — 2-30 grains (0.12-2.0 Gm.) [7^ grains (0.5 Gm), U. S. P.]. 

Zinci Iodidum— Zinci Iodidi— Zinc Iodide. V. S. JP. 

Origin. — Obtained by dissolving zinc oxide or carbonate in hydriodic acid, or 
digesting granulated zinc in 10 parts of iodine and 20 parts of water, and evaporating 
to dryness. 

Description and Properties. — A white, granular powder, odorless, and 
having a sharp, saline, and metallic taste. Very deliquescent, and liable to absorb 
oxygen from the air and to become brown from liberated iodine. Readily soluble in 
water, alcohol, or ether. Zinc iodide should be kept in small, glass-stoppered bottles. 

Dose. — 1-3 grains (0.06-0.18 Gm. ) [1 grain (0.65 Gm.), U. S. P.]. 

Sulphuris Iodidum— Sulphuris Iodidi— Sulphur 
Iodide. U. 8. P. 

Origin. Prepared by heating washed sulphur and iodine in a flask until the 

ingredients combine. 

Description and Properties.— Brittle masses, of a crystalline fracture and 
a grayish-black, metallic luster, having the odor of iodine and a somewhat acrid taste. 
Almost insoluble in water ; soluble in about 60 parts of glycerin ; very soluble in 
caibon disulphide. Alcohol and ether dissolve out the iodine, leaving the sulphur. 
Sulphur iodide should be kept in glass-stoppered bottles, in a cool place. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Plumbi Iodidum— Plumbi Iodidi— Lead Iodide. 

77. 8. JP. 

See Lead. 

Other compounds of iodine, used internally, are numerous. Some of those more 
recently brought to the practitioner's attention are: Iodic acid and its compound; 
iodine tribromide ; iodine trichloride ; iodopin, a compound of sesame oil and iodine, 
recommended as alterative ; iodo-albumin ; iodophenine, a combination of iodine and 
phenacetine, used in rheumatism in 8-grain doses ; iodopyrine, an analogous compound ; 
iodotheine (iodine and theine), a heart stimulant; iodotheobromin, analogous to the last, 
and iodolhyrin (see under Thyroid Extract). 

Antagonists and Incompatibles. — Iodine is incompatible with 
the alkaloids and most of the mineral salts and acids, and with 



468 A TEXT-BOOK OF MA TERIA MEDICA. 

ammonia. The iodides are incompatible with mineral acids and acid 
salts, bismuth subnitrate, alkaloids, silver nitrate, soluble lead salts, 
spirit of nitrous ether, potassium chlorate, licorice, and prepara- 
tions containing starch. The tincture of iodine is incompatible with 
water and aqueous preparations. 

Synergists. — Water, alkalies, and remedies increasing tissue 
waste. 

Physiological Action. — Externally and Locally. — Iodine is a 
powerful disinfectant and rubefacient, as well as vesicant, caustic, 
parasiticide, and antiseptic. When applied to the skin or mucous 
membrane it produces a yellow, brown, or black stain, and is irri- 
tant or caustic, according to the strength and frequency of the 
application. The discoloration, however, can be easily removed by 
sodium hyposulphite or ammonia. 

It combines with the albumin of the tissues and prevents putre- 
factive changes. When tincture of iodine is frequently applied or 
large amounts are used, desquamation of the skin is produced, and 
sometimes rapid vesication, or perhaps sloughing. The blood- 
vessels of the organs subjacent to the area to which it is applied 
are reflexly dilated, rendering this drug an efficient counterirritant. 

The vapor of iodine when inhaled produces considerable irrita- 
tion of the respiratory passages, exciting cough, sneezing, increased 
secretion of mucus, dyspnea, and more or less pain in the chest, 
although when inhaled in moderate amounts its antiseptic proper- 
ties exert a beneficial influence upon the bronchial tissues, prevent- 
ing decomposition of the secretions. 

The iodides have little local action. 

Internally. — Digestive System. — Taken internally in small doses, 
iodine acts as a gastric tonic, minute doses acting as a sedative, 
allaying nausea. In other cases a single moderate dose may occa- 
sion gastric uneasiness, larger amounts intensifying the discomfort 
and causing violent vomiting, increased salivary flow, abdominal 
pains, and purging. 

The iodides in moderate doses produce a sense of warmth in 
the stomach, larger amounts acting like iodine, though less irri- 
tating to the gastro-intestinal tract than the latter drug. 

Owing to their rapid diffusibility, the iodides can be tasted in a 
few minutes after their ingestion, considerably increasing the flow 
of saliva. 

Nervous System. — No special action is recorded, although the 
potassium iodide is known to occasion unpleasant symptoms, in- 
cluding distress of mind and depression of spirits, accompanied 
now and then by lassitude and muscular debility — symptoms due 
rather to the influence of potassium. 

Circulatory System. — The effects of iodine and its salts have been 
variously reported, it being claimed that their tendency is to contract 
the vessels and cause increased cardiac action. Introduced into the 
veins, a slight increase, followed by decrease of pressure, has been 
observed. The rapidity of elimination from the blood is doubtless 



A CIDS— ALKALIES-SAL TS. 469 

an impediment to any marked action on the circulation. Trasbot 
claims that potassium iodide dilates the blood-vessels, thereby in- 
creasing glandular secretion. 

The iodides are all supposed to be converted into the sodium 
iodide in the blood, without modifying the composition of that 
fluid. 

They probably form a loose combination with proteids. 

Respiratory System. — Little or no effect from medicinal doses 
has been noted. 

Absorption and Elimination. — Iodine and the iodides are rapidly 
absorbed by the mucous membranes generally, being found in the 
blood, mainly in combination with proteids. 

Elimination takes place by various channels — the urine, saliva, 
milk, intestinal and nasal mucous membranes. Salivary elimination 
appears to be even more active than the urinary process, although 
the drug escapes largely through the kidneys, increasing the amount 
of water, urea, uric, phosphoric, and sulphuric acids excreted. 
At the points of elimination the iodine is thought to escape in its 
nascent state, thus occasioning more or less irritation, and account- 
ing for the symptoms of iodism. 

It should be borne in mind that iodine, as iodothyrine, is a nor- 
mal constituent of the thyroid gland and in all probability the action 
of iodine in the body is conditioned very largely by the functioning 
of the thyroid and parathyroid glands. Certainly the action of the 
iodides on metabolism has some such relationship. 

Temperature. — Slight rises in temperature have been noted from 
prolonged dosage, possibly a reflex from the irritation of the 
skin, or an infection. 

Eye. — Beyond a local congestion of the minute vessels of the 
sclerotic coat under certain conditions, little effect has been ob- 
served. The symptoms of ocular iodism at times present are 
described under " Poisoning." 

Uterus. — Small doses may increase or hasten the menstrual 
flow and act as aphrodisiacs ; larger doses have a marked anaphro- 
disiac effect; while prolonged administration may result in atrophy 
of the ovaries. It has been maintained with authority that the 
catamenia are liable to increase, and that during pregnancy the drug 
may cause abortion. 

Untoward Action. — The untoward manifestations, in susceptible 
patients, are identical with those of iodism. 

Poisoning. — Taken in excessive doses, iodine acts as a poison, 
and has even produced death, though rarely. The symptoms of 
acute poisoning are those of severe gastro-enteritis, characterized 
by distressing stomachic and abdominal pains, accompanied by 
painful irritation of the esophagus, followed by violent purging and 
vomiting. 

An early symptom is a strong metallic taste in the mouth, to- 
gether with increased salivation. Suppression of urine, hiccough, 
and dysenteric pain have been reported in a fatal case resulting 



470 A TEXT-BOOK OF MATERIA MEDICA. 

from external application. Very immoderate doses are attended 
with rapid and feeble pulse, deathly pallor, severe renal irritation 
affecting urinary secretion, and final loss of vital power followed by 
respiratory failure. 

The condition induced by prolonged or excessive use of iodine 
or its salts is known as Iodism. Together with a metallic taste 
there are present tenderness of the teeth and gums, nausea, and 
symptoms of gastric irritation. 

Marked symptoms involving practically the entire respiratory 
mucous membrane, coryza, coughing, occasionally dyspnea, etc., 
this catarrh may extend to the conjunctivae. The skin is always 
involved — acneiform eruptions — even a vesicular and purpuric 
variety not unfrequently occurs. 

Moreover, muscular twitchings, edema of the glottis, neuralgic 
pains, and atrophy of mammae, testicles, and other tissues occasion- 
ally supervene. Anemia and even cachexia are often manifest. 

Treatment of Poisoning. — The use of large amounts of starch, 
in the form of arrowroot or starch-water, has been successfully 
adopted as an antidote. Hypodermic injections of ammonia, 
strychnine, digitalis, alcohol, and atropine have been employed 
with excellent results, as tending to restore the circulation and 
assist respiratory movements. More recently bicarbonate of so- 
dium has proved an efficient antidote. 

The use of the gastric siphon and the application of heat to the 
body and extremities are naturally of the first importance. 

Therapeutics. — Externally and Locally. — The tincture, com- 
pound solution, and ointment are extensively employed as coun- 
terirritants and as aids to the absorption of fluid. The tincture is 
an efficient application to joints in chronic rheumatism, gout, and 
synovitis, and in pleurisy, both for the purpose of aborting an attack 
and to aid the absorption of fluid when effusion has taken place. 
In neuritis, onychia, periostitis, venereal bubo, glandular swellings, etc., 
the tincture, applied externally, will often be of service. Combined 
with tincture of aconite, equal parts, a useful application to sore 
gums is secured. The tincture of iodine has been recommended 
as an efficient application in recession of the gums attendant upon 
pyorrhea alveolaris. 

This same preparation is of marked benefit when hypodermi- 
cally injected in goiter, particularly of the soft or cystic variety, 
hydrocele, empyema, extensive serous arthritic effusion unaccompanied 
by inflammation, spinal meningocele, and anal fistula. 

The tincture is also a very efficient application in chrojtic metritis 
and chronic endometritis. 

In many diseases of the skin iodine serves a useful purpose as 
a discutient and parasiticide, lentigo, lupus, chloasma, tinea tonsurans, 
etc., especially indicating its use. 

The vapor of iodine is frequently employed in subacute catarrhal 
deafness and in acute coryza. 

A mixture of tincture of iodine \ fluidrachm (2.0 Cc), carbolic 



A CIDS— ALKALIES— SAL TS. 47 1 

acid 10 minims (0.6 Cc), glycerin and water, each, \\ ounces 
(45.0 Cc), has been highly recommended by Samuel Johnston in 
the treatment of chronic pharyngitis. 

As an inhalant in chro7iic laryngitis and phthisis iodine in some 
form is highly esteemed by many physicians. 

Many iodine substituted derivatives are in active use as antiseptics, 
(see Antiseptics, Iodoform, etc.). 

Internally. — One of the principal and most important uses of 
iodine and the iodides is in the treatment of secondary and tertiary 
syphilis. All the manifestations of this disease, such as syphilitic 
periostitis, meningitis, endarteritis, gummata, paralysis, etc., are re- 
lieved by large doses of the iodides to saturation of the system. 

Iodine is peculiarly useful in combining with and eliminating 
mercury from the system of patients suffering from mercurial 
cachexia, paralysis, etc. Other metals — lead, etc. — are readily elim- 
inated by a course of potassium iodide. 

Potassium iodide is of marked utility in arresting the various 
manifestations of scrofula, such as inflammation and ulceration of 
cartilaginous structures and mucous catarrhs, and hastening the reso- 
lution of adenitis and enlargement of lympJiatics. 

With regard to the use of iodide in the treatment of aneurism 
of the aorta Walshe says : " Not only has relief of neuralgic pains 
and of the general distress followed its administration, but the local 
pressure-symptoms have been mitigated, and firm thrombosis has 
taken place within the sac, while the area of pulsation and of per- 
cussion-dulness has exhibited sensible reduction." Other authori- 
ties have reported favorably of its use in this condition. 

As cardiac tonics the iodides are of undoubted value, being 
especially serviceable in fatty degeneratio?i of the heart, and for the 
mitigation of the symptoms of chronic valvular diseases of the heart, 
especially those of the aortic orifice. It is a particularly useful 
remedy in chronic asthma and bronchitis, and to hasten the removal 
of inflammatory products of pneumonia, pleurisy, and pericarditis. 

The spasmodic asthma of adults and the bronchitis of children, 
both of which alternate with eczematous attacks, are greatly relieved 
by potassium iodide. 

Even hereditary asthma occurs at less frequent intervals and in 
a milder form when the patient is kept constantly under the influ- 
ence of moderate doses of this drug. 

In the early stages of cirrhosis, whether of the liver or kidneys, 
potassium iodide is a useful remedy. The dropsy of splenic or hepatic 
induration is relieved by iodine, while in the various forms of 
muscular rheumatism it is one of the most potent medicaments. It 
has been advocated as a successful remedy in sciatica and chronic 
gout. 

Ammonium iodide is highly recommended as an efficient rem- 
edy in acute catarrhal pneumonia and capillary bronchitis. It is 
especially useful in catarrhal jaundice, and has, moreover, been 
suggested as a good remedy in hay fever. 



472 A TEXT-BOOK OF MATERIA MEDICA. 

The syrup of hydriodic acid has been commended by Craig 
as a valuable agent in acute rheumatism. Small doses of the tinc- 
ture of iodine have been found efficient in the vomiting of pregnancy. 

Contraindications. — The drug should be discontinued at once 
when symptoms of iodism appear. It is contraindicated also in 
pulmonary tuberculosis when there is a rapid change taking place 
in the lung. The iodides should not be given immediately before 
or after the administration of quinine. 

Administration. — The sodium iodide is less active and toxic 
than the potassium salt. The strontium iodide may be used for 
the same purpose as the other iodides, and possesses the advantage 
of disturbing the stomach less, besides being less likely to produce 
iodism. 

The iodides should be given in a large quantity of liquid. Their 
unpleasant taste may be concealed to a considerable extent by 
dissolving them in carbolic-acid water or Vichy water. Milk, com- 
pound syrup of sarsaparilla, and current and raspberry syrups have 
all been used for this purpose. 

It is said that tincture of belladonna or sodium bicarbonate 
prevents the coryza caused by the iodides. 

The syrup of hydriodic acid is more pleasant to the taste, and 
has but little tendency to produce iodism or untoward effects. 
This preparation should always be administered upon an empty 
stomach. The syrup of the iodide of wine is a useful combination 
in the cachexia of syphilis. 

MINERAL WATERS. 

The line of demarcation between mineral and ordinary waters 
cannot be definitely drawn. Although in the former there is usu- 
ally present an increase of mineral constituents or of temperature, 
some drinking waters contain more mineral ingredients than others, 
while many very pure waters, both cold and warm, have been re- 
garded for ages as mineral springs. 

Although especially abundant in volcanic regions, mineral springs 
are by no means confined to them. They have been found on 
alpine heights — even at the snow-line in the Himalayas — and they 
rise from the bottom of the sea, as at Baiae and Ischia. 

The foreign ingredients of mineral waters, as shown by analysis, 
are very numerous, some of them occurring in exceedingly minute, 
others in large, quantities. Among them are soda, magnesium, 
calcium, potash, alumina, iron, boron, iodine, bromine, arsenic, 
lithium, cesium, rubidium, fluorine, barium, copper, zinc, manga- 
nese, strontium, silica, phosphorus, besides extractive substances 
and various organic deposits known under various names. The 
constituent gases include carbonic and hydrosulphuric acids, nitro- 
gen, oxygen, hydrogen, and ammonia. Of all these, by far the 
most important from a therapeutic point of view are sodium, mag- 
nesium, iron, carbonic acid, sulphur, and perhaps hydrosulphuric acid. 



A CIDS- ALKALIES- SAL TS. 473 

These combinations are very numerous, some waters containing 
from 10 to 20 per cent, of them; yet there are always certain pre- 
dominating constituents which mark the character of the spring, 
while many substances, such as cesium, rubidium, or fluorine, occur 
in mere traces and must be regarded as unimportant 

Mineral waters may be considered, therefore, as weaker or 
stronger solutions of salts and gases of higher or lower temperature, 
although the quantity of saline ingredients commonly bears but a 
very small proportion of that of the fluids containing them. For 
purposes of therapy they are used either externally in the form of 
baths or internally as beverages. With regard to the former use — 
or, to speak technically, balneotherapy- — the scope of the present 
work precludes treatment in extenso. Enough to say that in certain 
conditions the system is uudoubtedly benefited by resort to baths 
of various characters, especially when accompanied by the accessory 
aid of well-considered diet and regimen. 

The literature connected with the subject of potable waters is 
voluminous, yet the deductions drawn by various observers touch- 
ing their efficacy and in relation to the comparative value of natural 
springs are too frequently colored by individual bias, or based upon 
too hasty analysis to furnish infallible data or warrant the definite 
statement possible in ordinary therapeutics. That certain waters 
charged with foreign ingredients when ingested react upon the 
body favorably in the case .of certain disorders it were futile to 
deny. Yet even here there are subsidiary considerations not to be 
ignored ; and it is an open question how far the patient may be 
relieved by the potency of the remedy per se, or whether the col- 
lateral aids of environment, climate, altitude, temperature, etc., may 
not have an important bearing upon beneficial results. 

It has been well observed that in the case of water taken in situ 
the curative atmosphere of the surroundings, the favorable season 
of the year, the reflex influence of social amenities, and freedom 
from customary cares, aided by studied regimen under constant 
medical supervision, play no unimportant part in the alleviation of 
positive or imaginary disorders. The maxim, " Amuse the patient 
and let nature work the cure," seems not wholly inapplicable to 
many fashionable resorts where a constant round of gayety acts as 
a practical, though imperceptible, tonic or stimulant upon subjects 
of certain nervous susceptibilities. These considerations are no 
less forcible in the case of American " watering-places " than in 
those of the more famous resorts of Europe. 

Various attempts have been made to arrange mineral waters 
according to their therapeutic action, their external and internal 
effects physiologically, and, most frequently, according to their 
chemical composition. Yet their influence is so dependent upon 
idiosyncrasy and their constituents so varied that it is well-nigh 
impossible to select a definite system free from objections, although 
a scientific classification, uniformly adopted, would undoubtedly 
promote their rational employment. Many sulphur waters are 



474 A TEXT-BOOK OF MA TERIA MEDICA. 

practically earthy or saline ones, yet the presence of minute quan- 
tities of hydrosulphuric acid, an ingredient so palpable as always 
to attract attention, has determined a classification obviously at 
variance with natural fact. The general rule has been to class 
waters under the head of their predominating elements, the desid- 
eratum being comparative simplicity untrammelled by theoretical 
considerations. 

Alkaline. — These waters owe their chief therapeutic value to 
the alkaline salts they contain. They are rich in alkaline car- 
bonates, especially the sodium carbonate. Other substances are 
included among their ingredients, many of them strongly charged 
with carbonic-acid gas, w r hich may possibly contribute to their 
physiological activity. 

Saline. — These either contain (i) chloride of sodium as the 
principal ingredient, or (2) are largely impregnated with the sul- 
phates of sodium and magnesium. Several other ingredients enter 
into their composition, yet their efficacy chiefly depends upon their 
predominating elements ; the second class includes the bitter or 
purgative waters highly prized both in this country and abroad. 

Sulphuretted. — The sulphuretted hydrogen present in these 
waters lends to them their chief therapeutic value. They contain 
also various sulphides — of potassium, sodium, calcium, and mag- 
nesium — together with earthy and other sulphates, which doubtless 
contribute in a measure to their potency as physiological agents, 
although their action upon the system is still a matter of con- 
jecture. 

Chalybeate. — Many mineral springs contain iron, yet in 
amounts so insignificant as to be of little value to therapy. There 
are, however, chalybeate waters highly charged with iron salts in 
the form of the carbonate or sulphate which have acquired a repu- 
tation for efficacy in the treatment of certain diseases. 

Acidulous. — The valuable property of these springs lies in the 
superabundance of carbonic-acid gas they contain, to which the 
solid constituents are subordinate, the carbon dioxide being the 
important therapeutic ingredient. 

Calcareous. — Calcium, in the form of the carbonate, is the 
valuable constituent of calcareous waters. Besides this substance 
they contain magnesium carbonate in varying quantities. Their 
utility as mineral waters has been questioned, many authorities 
refusing them recognition as therapeutic agents. 

The following enumeration of native springs is from the admi- 
rable list compiled by Dr. A. N. Bell : 

Berkshire, Vermont. 



Alkaline : 

Adams, California. 
Albury, Vermont. 
Alma, Michigan. 
Alum, Virginia. 



Borax, California. 
Blount, Alabama. 
Canon City, Colorado. 
Carlisle, Colorado. 
Congress, California. 



A CIDS— ALKALIES—SAL TS. 



475 



Elgin, Vermont. 
Fry's Soda, California. 
Greencastle, Indiana. 
Highgate, Vermont. 
Highland, California. 
Kittrell's, North Carolina. 
Lower Soda, California. 
Madison, Georgia. 
Manitou, Colorado. 
Manley, North Carolina. 
Middletown, Vermont. 
Milford, New Hampshire. 
Montvale, Tennessee. 
Napa Soda, California. 
Newbury, Vermont. 
Owasso, Michigan. 
Perry, Illinois. 
Ravenden, Arkansas. 
Rocky Mountain, Colorado. 
Rowland's, Georgia. 
Schooley's Mountain, New 

Jersey. 
Schuyler County, Illinois. 
South Park, Colorado. 
Sparta, Wisconsin. 
Versailles, Indiana. 

Purgative Saline: 

Alma, Michigan. 
Blue Lick, Kentucky. 
Crab Orchard, Kentucky. 
Elgin, Vermont. 
Esculapian, Kentucky. 
Harrodsburg, Kentucky. 
Midland, Michigan. 
Pagosa, Colorado. 

Saline : 

Fruit-Port Well, Michigan. 

Grand Haven, Michigan. 

Louisville Artesian, Ken- 
tucky. 

Michigan Congress, Michi- 
gan. 

Mt. Clemens, Michigan. 

Ocean, Alabama. 

St. Louis, Missouri. 

Salt, Virginia. 



Spring Lake Well, Michi- 
gan. 

Sulphurous : 

Alpena, Michigan. 
Balston, New York. 
Bladon, Florida. 
Blue Lick, Kentucky. 
Carlisle, Pennsylvania. 
De Soto, Louisiana. 
Sheldon, Vermont. 
Summit, Maine. 

Thermal Springs : 

Agua Caliente, New Mexico. 
Arrow-Head, California. 
Buncombe County, North 

Carolina. 
Calistoga, California. 
Chalk Creek Hot, Colorado. 
Charleston Artesian, South 

Carolina. 
Des Cahutes Hot, Oregon. 
Seltzer, California. 
Sheldon, Vermont. 
Summit Soda, California. 
Vichy, California. 
Wilholt Soda, California. 

Calcic : 

Bethesda, Wisconsin. 
Butterworth, Michigan. 
Birch-Dale, Vermont. 
Clarendon, Vermont. 
Eaton Rapid, Michigan. 
Gettysburg, Pennsylvania. 
Hubbardstown, Michigan. 
Silurian, Wisconsin. 

Chalybeate : 

Abbeville, South Carolina. 
Alma, Michigan. 
Bedford, Pennsylvania. 
Blossburg, Pennsylvania. 
Cooper's Well, Mississippi. 
Esbitt, Kentucky. 
Fayette, Pennsylvania. 



476 



A TEXT-BOOK OF MA TERIA MEDICA. 



Dremion, Kentucky. 
French Lick, Indiana. 
Glenn's, South Carolina. 
Gordon's, Georgia. 
Highgate, Vermont. 
Indian, Georgia. 
Indian, Indiana. 
Lodi Artesian, Indiana. 
Man ley, North Carolina. 
Minnequa, Pennsylvania. 
Montesano, Missouri. 
Olympian, Kentucky. 
Portea Springs, Colorado. 
Salt Sulphur, Virginia. 
Saratoga, New York. 
Sharon, New York. 
Sheldon, Vermont. 
Shocco, North Carolina. 
St. Helena White Sulphur, 

California. 
St. Louis, Michigan. 
Sweet, Missouri. 
Valhemosa, Alabama. 
West Baden, Indiana. 
White Sulphur, Louisiana. 
White Sulphur, Montana. 
White Sulphur, Virginia. . 



Unclassified : 
Alum, Virginia. 
Birch-Dale, New Hampshire. 
Borax, California. 
Climax, Missouri. 
Eureka, Arkansas. 
Fairview, Texas. 
Geysers, the American, Wyo- 
ming. 
Geyser Spa, California. 
Greeneleone, Florida. 
Harbines, California. 
Hot Springs, Arkansas. 
Idaho Hot, Colorado. 
Iodide and Bromide, Missouri. 
Merriweather, Georgia. 
Middle Park Hot, Colorado. 
Ojo Caliente, New Mexico. 
Paraiso, California. 
Passo Robles, California. 
Piedmont, Texas. 
Salt Lake, Utah. 
Seigler, California. 
Skaggs, California. 
Stafford, Connecticut. 
Volcano, Nebraska. 
Warm and Hot, West Virginia. 



ACIDS. 



MINERAL ACIDS. 

There are certain characteristics common to all the mineral acids 
which claim primary attention : 

Concentrated mineral acids are caustic to a greater or less degree. 

They combine with alkalies and alkaline earths to form salts, 
and unite with vegetable acids, setting them free from their combi- 
nation with bases. When in contact with the tissues of the body 
they combine with the protoplasm, neutralizing the alkalies which 
the latter contains and forming mineral salts. They also combine 
with the albumin, forming acid albumin. 

They diminish the functional activity of the muscular and ner- 
vous systems. Applied locally in a concentrated form, or taken 
internally in poisonous doses, they tend to produce rigidity of the 
muscles by coagulating the myosin. 

The alkalinity of the blood is lessened, ammonia and the fixed 
alkalies of the blood and cells being called on to counteract the 
action of the acid, and the acidity of the urine is increased by the 
internal administration of practically all of the mineral acids. 



A CIDS— ALKALIES—SAL TS. 477 

Acidum Hydrochloricum— Acidi Hydrochlorici— 
Hydrochloric Acid. JJ. S. P. 

(Muriatic Acid.) 

Origin. — A liquid composed of 31.9 per cent, by weight of absolute hydro- 
chloric acid (HCL = 36.38) and 68.1 percent, of water. 

Description and Properties. — A colorless, fuming liquid, of a pungent odor 
and an intensely acid taste. Fumes and odor disappear on diluting the acid with 2 
volumes of water. Specific gravity about 1.098 at 25 C. (77 F.). Miscible in all 
proportions with water and alcohol. Hydrochloric acid should be kept in dark, 
amber-colored, glass-stoppered bottles. 

Official Preparations. 

Acidum Hydrochloridum Dilutum — Acidi Hydrochlorici Diluti — Diluted 
Hydrochloric Acid (Diluted Muriatic Acid). — Formula: Hydrochloric acid, 
loo ; distilled water, 219. 

Dose. — 10-20 minims (0.6-1.2 Cc.) [15 minims (7 Cc), U. S. P.]. 

Acidum Nitrohydrochloricum — Acidi Nitrohydrochlorici — Nitrohydro- 
chloric Acid. (Described under Nitric Acid.) 

Dose. — 2-5 minims (0.12-0.3 Cc), well diluted [3 minims (0.2 Cc), U. S. P.]. 

Acidum Nitrohydrochloricum Dilutum — Acidi Nitrohydrochlorici Diluti 
— Diluted Nitrohydrochloric Acid. (Described under Nitric Acid.) 

Dose. — 5-20 minims (0.3-1.2 Cc.) [15 minims (1 Cc), U. S. P.]. 

Acidum Phosphoricum— Acidi Phosphorici— 
Phosphoric Acid. IT. S. P. 

Origin. — A liquid composed of not less than 85 per cent, by weight of absolute 
orthophosphoric acid (H 3 P0 4 = 97.8) and not more than 15 per cent, of water. 

Description and Properties. — A colorless liquid, without odor, but having 
a strongly acid taste. Specific gravity not below 1.707 at 25 C. (77 F.). Miscible 
in all proportions with water or alcohol. Phosphoric acid should be kept in glass- 
stoppered bottles. 

Dose. — The diluted acid only is given internally. 

Official Preparation. 

Acidum Phosphoricum Dilutum — Acidi Phosphorici Diluti — Diluted Phos- 
phoric Acid. — Diluted phosphoric acid contains 10 per cent, by weight of absolute 
orthophosphoric acid. 

Dose. — 5-25 minims (0.3-1.5 Cc.) [15 minims (2 Cc), U. S. P.]. 

Acidum Sulphuricum— Acidi Sulphurici— Sulphuric 

Acid. V. S. JP. 

Origin. — A liquid composed of not less than 92.5 per cent, by weight of abso- 
lute sulphuric acid (H 2 S0 4 = 97.82) and not more than 7.5 per cent, of water. 

Description and Properties. — A colorless liquid of oily consistence, inodor- 
ous, and very caustic and corrosive. Specific gravity not below 1.826 at 25 C. (77° 
F. ). Miscible in all proportions with water and alcohol, with evolution of so much 
heat that the mixing requires great caution. Sulphuric acid should be kept in glass- 
stoppered bottles. 

Official Preparations. 

Acidum Sulphuricum Aromaticum — Acidi Sulphurici Aromatici — Aro- 
matic Sulphuric Acid. — Formula : Sulphuric acid, 1 10 ; tincture of ginger, 50 ; oil 
of cinnamon, I ; alcohol to make 1000 parts. 

Dose. — 5-20 minims (0.3-1.2 Cc.) [15 minims (1 Cc), U. S. P.]. 



478 A TEXT-BOOK OF MATERIA MEDICA. 

Acidum Sulphuricum Dilutum — Acidi Sulphurici Diluti — Diluted Sul- 
phuric Acid. Diluted sulphuric acid contains 10 per cent, by weight of absolute sul- 
phuric acid. 

Dose. — 5-20 minims (0.3-1.2 Cc. ) [30 minims (2 Cc), U. S. P.]. 

Acidum Nitricum— Acidi Nitrici— Nitric Acid. 

77. S. jP. 

Origin. — A liquid composed of 68 per cent, by weight of absolute nitric acid 
(HNO3 = 62.89) ar) d 32 per cent, of water. 

Description and Properties. — A colorless, fuming liquid, very caustic and 
corrosive, and having a peculiar, somewhat suffocating odor. Specific gravity about 
1.403 at 25 C. (77 F.). Nitric acid should be kept in dark, amber-colored, glass- 
stoppered bottles. 

Official Preparatioris. 

Acidum Nitricum Dilutum — Acidi Nitrici Diluti — Diluted Nitric Acid. — 

Diluted nitric acid contains 10 per cent, by weight of absolute nitric acid. 

Dose. — 5-20 minims (0.3-1.2 Cc.) [30 minims (2 Cc. ), U. S. P.]. 

Acidum Nitrohydrochloricum — Acidi Nitrohydrochlorici — Nitrohydro- 
chloric Acid. — Formula: nitric acid, 180; hydrochloric acid, 820 parts. 

Description and Properties. — A golden yellow, fuming, and very corrosive liquid, 
having a strong odor of chlorine. Completely volatilized by heat. It readily dissolves 
gold-leaf, and a drop of it added to potassium iodide T. S. liberates iodine. 

Dose. — 1-3 minims (0.06-0.18 Cc.) [3 minims (0.2 Cc), U. S. P.]. 

Acidum Nitrohydrochloricum Dilutum — Acidi Nitrohydrochlorici Diluti — 
Diluted Nitrohydrochloric Acid. — Formula: nitric acid, 40; hydrochloric acid, 
182 ; distilled water, 780 parts. Dose, 5-20 minims (0.3-1.2 Cc.) [15 minims (1 Cc), 
U. S. P.]. 

Antagonists and Incompatibles. — Hydrochloric acid and its 
preparations are incompatible (forming explosive compounds) with 
oxidizable substances — phosphorus, sulphur and the sulphides, 
alcohols, ethers, carbohydrates, etc. All the mineral acids are in- 
compatible with the alkalies and their carbonates, salts of lime, lead, 
and silver, and decompose glycosides. 

Synergists. — The action of hydrochloric acid upon the digest- 
ive system is aided by the digestive ferments and the vegetable 
bitters. 

Physiological Action. — The general action of mineral acids 
upon the various systems is herewith given in detail : 

Externally and Locally. — Applied in a concentrated form to the 
skin or to any tissue of the body, acids abstract the water from 
the tissues and destroy the protoplasm, acting as escharotics. 
Weaker solutions vesicate, merely inflaming the parts to which they 
are applied, without destroying the tissue, while extremely diluted 
or weak solutions are irritant and astringent. 

Internally. — Digestive System. — Diluted acids only should be 
administered internally. Save with reference to the poisonous 
effects of concentrated acids, therefore, the physiological action of 
diluted acids only will be here considered. 

The salivary glands are stimulated, resulting in an increased flow 
of saliva, moistening the mouth and allaying thirst. The appetite 
and digestion are improved, and the secretions from the liver and 
the duodenal glands are increased. Long-continued use of the 



A CIDS— ALKALIES—SAL TS. 479 

mineral acids impairs digestion by lessening the normal secretion 
of the gastric glands, while protracted use may produce salivation 
and a train of symptoms — anemia, loss of flesh, etc. Mineral acids 
tend to constipate. 

Nervous System. — Medicinal doses, so far as observed, produce 
no special action upon the nervous system. 

Circulatory System. — Diluted acids in medicinal doses cause a 
rise in blood-pressure and increased action of the heart, probably 
due to their stimulating action on the vasomotor mechanism. 
Concentrated acids relax the muscular tissue of both the heart 
and blood-vessels. Mineral acids combine with the albumin or the 
alkaline bases of the blood, lessening the alkalinity of that fluid. 

Respiratory System. — No important action under medicinal doses 
has been observed. 

Absorption and Elimination. — Mineral acids, above all hydro- 
chloric acid, are readily absorbed. Diluted acids are converted 
into neutral salts in the intestines, and are absorbed as such. The 
excess of the acid which does not enter into combination in the 
stomach and intestines is rapidly absorbed into the blood, combin- 
ing with its alkaline bases, and in this form is excreted, principally 
by the kidneys, as acid salts. 

Temperature. — Medicinal doses have no influence upon temper- 
ature. 

Untoward Action. — Mineral acids under too-prolonged admin- 
istration impair the appetite and disturb digestion, occasioning 
toothache and gastric oppression, and at times salivation and diar- 
rhea. They may also produce anemia, paleness of skin, and loss 
of flesh (Nothnagel and Rossbach). When taken for long periods 
and in comparatively large quantities they have a distinct degen- 
erative action on the heart, the liver, and the kidneys. The pro- 
longed use of nitric acid may produce erosion of the gums and 
tongue, with loosening of the teeth. Chromic acid and osmic acid 
act very energetically on the parenchyma of the kidneys. 

Poisoning. — The mineral acids when taken in a concentrated 
form and in toxic doses act as corrosive poisons, causing intense 
burning in the stomach and intestines and active gastric inflamma- 
tion. Violent vomiting occurs, the ejected matter containing blood, 
and, in the case of hydrochloric acid, a white cloud of ammonium 
chloride is discerned if the ejecta be placed near the vapor of 
ammonia. 

The respiration is greatly depressed, and there is a strong, per- 
sistent acid taste in the mouth, the mucous membrane of which is 
discolored, while the tongue is swollen and inflamed. There is 
great thirst, and the pulse becomes rapid and tense. The tempera- 
ture, at first elevated, soon falls below normal, profound prostration 
supervening, and death resulting either from shock or from second- 
ary inflammation. 

A postmortem examination shows the results of corrosive poi- 
soning : ulceration or evidences of intense inflammation of the 



480 A TEXT-BOOK OF MA TERIA MEDICA. 

mucous membrane of the mouth, esophagus, stomach, and intes- 
tines. Occasionally the walls of the latter are perforated. Should 
death be delayed for some time, fatty degeneration of the kidneys 
and other internal organs is found. 

Treatment of Poisoning. — This should be prompt. The cautious 
administration of alkalies is indicated to neutralize the acid, though 
the evolution of carbonic-acid gas resulting from some may rupture 
the stomach. The stomach should be washed out, and this treat- 
ment followed by demulcent drinks and oil, milk, and eggs. Opium 
may be necessary for the relief of pain, and brandy or whiskey 
subcutaneously in case of collape. 

Therapeutics. — Externally and Locally. — Hydrochloric acid 
is employed as a caustic in noma and putrid sore throat. Mixed 
with two or three parts of honey, it is an efficient application to 
the throat in diphtheria. Andrews and Morris have recommended 
diluted hydrochloric acid for the removal of sequestra, and Chas- 
saignac has utilized the acid in removing necrosed bone in osteitis 
and caries. 

Nitric acid is a much more powerful caustic, and as such is 
used more extensively than any other mineral acid, because of its 
limited action and the ease with which it is controlled. It is an 
excellent caustic in cases of cancer of the cervix, venereal warts, 
hospital gangrene, phagedenic ulceration, hemorrJwids, and prolapse 
of the rectum, especially in the case of children. In cases also of 
fungoid granulation and excessive hemorrhage from the uterus it 
has been highly recommended. In certain diseases of the throat, 
nose, and ear this acid has been used for the destruction of growths, 
as well as for its escharotic action in ulcerated conditions. 

Dermatologists find nitric acid to be an efficient application for 
the removal and destruction of epithelioma, moles, ?ievi, chloasma, 
etc., caution being exercised in the latter case merely to produce 
an exfoliation of the skin, not sufficient destruction of tissue to 
result in a cicatrix. 

Liveing recommends a very weak solution of nitric acid with 
tincture of opium in pruritis. 

Phosphoric acid, in the strength of 50 grains (3.2 Gm.) to the 
ounce (30.0 Cc.) of distilled water, has been suggested by Grossich 
in the treatment of scrofulous idcers, and an injection of this solu- 
tion into tuberculous gla)ids of the neck is highly recommended by 
the same authority. 

Sulphuric acid is perhaps the most persistent, irritating, and 
destructive caustic known. Its affinity for water, and its conse- 
quent extensive action, render it, when used alone, unfit for caustic 
purposes. Mixed with powdered charcoal, however, it forms a 
paste which is an efficient caustic application to chancres, cancers, 
etc. Frazer considers the strong sulphuric acid the best caustic in 
the bites of rabid animals. Diluted solution, in the proportion of 
6 parts of the strong acid to 4 parts of diluted alcohol, has been 
recommended for cpistaxis. 



ACIDS— ALKALIES— SALTS. 481 

The eschar formed by the three chief mineral acids is of diag- 
nostic interest. Sulphuric acid, brown to black ; nitric acid, yellow ; 
hydrochloric acid, white to grayish-white. 

Internally. — Hydrochloric acid, being a normal constituent of 
the stomach, is indicated in certain forms of gastric dyspepsia, par- 
ticularly in the atonic variety. In these latter cases there is usually 
decomposition and fermentation of food, which condition is greatly 
relieved by the administration of pepsin or hydrochloric acid after 
meals, or the same with bitters before meals. 

In intestinal indigestion hydrochloric acid is an admirable rem- 
edy, given one to two hours after meals. 

The diluted hydrochloric acid is a useful remedy in the treatment 
of typhoid. It allays thirst, moistens the tongue, aids digestion 
and exerts an antiseptic influence in the bowels, thereby lessening 
the flatus. 

In certain affections of the skin dependent upon deranged diges- 
tion, hydrochloric acid often proves a potent remedy. 

Nitric acid has been used for the same purposes as hydrochloric 
acid, although for digestive disorders it is inferior to the latter drug. 

In intermittent and periodical fevers, however, nitric acid is an 
efficient remedy. In hepatic disorders the diluted nitrohydrochloric 
acid deservedly holds a high place as a remedial agent, and the 
same remedy is frequently employed with success in chronic syphilis i 
but solely by reason of its improving the appetite. 

In the conditions known as oxaluria and lithemia nitric and 
nitrohydrochloric acids serve an excellent purpose. 

The aphonia of singers and public speakers is often relieved by 
the diluted nitric acid, certain cases of bronchitis being also bene- 
fited by the same remedy. 

Phosphoric acid has acquired some reputation as a remedy 
in anemia and as a tonic in wasting diseases and neurasthenia. Its 
value, however, is based more upon hypothesis than upon the 
results of clinical observation. 

Possibly phosphoric acid is superior to the other mineral acids 
only in its action in diabetes, in which disease it certainly possesses 
a remarkable influence in diminishing thirst and lessening the 
secretion of urine. 

Sulphuric acid is inferior to nitric or nitrous acid in serous 
diarrhea. It is nevertheless an invaluable, as well as an old and 
tried, remedy in cholera. 

This remedy also deserves favorable consideration in the treat- 
ment of acute lead-poisoning. Moreover, in chronic lead-poisoning 
water acidulated with sulphuric acid makes an efficient prophylactic, 
and the remedy has also been suggested as a preventive of Asiatic 
cholera. 

Owing to its astringent and antiseptic properties this acid, par- 
ticularly the aromatic sulphuric acid, proves a good remedy in cer- 
tain cases of diarrhea. It is especially valuable in limiting the 
sweating in phthisis. 

31 



482 A TEXT-BOOK OF MA TERIA MEDICA. 

In scurvy and purpura, sulphuric acid has proved valuable, and 
it has been recommended as an internal remedy in lichen, prurigo, 
and many itching diseases of the skin. 

Contraindications. — Acute inflammation of the stomach, rheu- 
matism, gout, and where the urine is excessively acid and of high 
specific gravity. 

Administration. — Only the diluted acids should be given in- 
ternally, and even these should be further diluted, and taken, if 
possible, through a glass tube, to prevent injury to the enamel of 
the teeth. They are best given after meals, and should not be 
administered for too long a period ; and the first indication of 
untoward action, such as griping, diarrhea, etc., is to be taken as a 
warning that the drug must be withdrawn. 

ORGANIC ACIDS. 

Acidum Lacticum— Acidi Lactici— Lactic Acid. 

U. S. P. 

Origin. — An organic acid usually obtained by subjecting milk sugar or grape sugar 
to lactic fermentation. It is composed of 75 per cent, by weight of absolute lactic acid 
(CHC 3 H 5 3 = 89.79) and 25 per cent, of water. 

Description and Properties. — A colorless, syrupy liquid, odorless, of a 
purely acid taste, and absorbing moisture on exposure to damp air. Specific gravity 
about 1.206 at 25 C. (77 F.). Freely miscible with water, alcohol, or ether; insol- 
uble in chloroform, benzin, or carbon disulphide. 

Dose. — 20-30 minims (1.2-1.8 Cc), diluted and sweetened. [30 minims (2 Cc), 
U. S. P.]. 

Official Preparation. 

Syrupus Calcii Lactophosphatis— Syrupi Calcii Lactophosphatis — Syrup 
of Calcium Lactophosphate. — Formula: precipitated calcium carbonate, 25; lactic 
acid, 60 ; phosphoric acid, 36; orange-flower water, 55; sugar, 725; water, q. s. ad 
1000. Dose, 1-2 fluidrachms (3.7-7.3 Cc.) [2 fluidrams (8 Cc), U. S. P.]. 

Antagonists and Incompatibles. — Alkalies and the salts of 
the mineral acids are incompatible with lactic acid. 

Synergists. — Pepsin, vegetable acids, hydrochloric acid, and 
sodium chloride. 

Physiological Action. — Externally a?id Locally. — Lactic acid is 
a caustic to highly organized tissues, resembling the mineral acids in 
its local action. It can dissolve false membrane. 

Internally. — Digestive System. — It is thought to be present in 
the stomach during the first forty-five minutes of stomachic diges- 
tion, but cannot be considered a normal constituent of the gastric 
juice. 

Nervous System. — Large doses are thought to depress the 
nervous system. 

Circulatory System. — Being absorbed from the stomach, it com- 
bines with bases in the blood, forming lactates which are rapidly 
converted into carbonates. 

Absorption and Elimination. — It is absorbed from the stomach, 



A CIDS— ALKALIES— SAL TS. 483 

undergoes a change in the blood, and is eliminated by the kidneys, 
although, according to Lehmann, when large doses have been 
taken it is found in the urine unchanged ; and we have Benzelius 
and Scherer as authorities that lactic acid can be detected in the 
spleen and the muscular fluid. It has been found in the exudates 
in puerperal fever. 

Untoward action, poisoning, and treatment of poisoning are 
similar to those of the mineral acids. 

Therapeutics. — Externally and Locally. — It has been used 
locally for the same purposes as the mineral acids, but it is 
thought by many clinicians to be superior to the latter in tuber- 
culous ulceration. 

As a solvent of false membranes lactic acid is unquestionably 
superior to the mineral acids, being highly recommended for this 
purpose in diphtheria and croup by many authorities. 

Internally. — Digestive System. — It is used in the digestive dis- 
orders, such as atonic and irritative dyspepsia, and in all those 
derangements of digestion which are benefited by hydrochloric 
acid. In oxaluria, lithemia, chronic cystitis with ammoniacal urine, 
chronic dysentery, and dyspeptic and tuberculous diarrhea it has 
proved an efficient remedy. It has been recommended as a 
prophylactic in gout. 

Since this drug was suggested by Cantani as a remedy in dia- 
betes mellitus it has been used with varying success. Balfour and 
Foster, as well as Cantani himself, have reported many cases 
which have greatly improved under the administration of lactic acid 
accompanied by an appropriate dietetic regimen. 

Contraindications. — The same as for mineral acid. 

Administration. — Lactic acid should be given well diluted. 

Acidum Aceticum— Acidi Acetici— Acetic Acid. 

U. S. P. 

Origin. — A liquid composed of 36 per cent, by weight of absolute acetic acid 
(HC 2 H 3 2 = 59.86) and 64 per cent, of water. 

Description and Properties. — A clear, colorless liquid, having a strong, 
vinegar-like odor, a purely acid taste, and a strongly acid reaction. Miscible with 
water or alcohol in all proportions. 

Dose. — The diluted acid only is given internally. 

Official Preparations. 

Acidum Aceticum Dilutum — Acidi Acetici Diluti— Diluted Acetic Acid (6 
per cent.). Dose. — 1-2 fluidrachms (3.7-7.4 Cc.) [30 minims (2 Cc), U. S. P.]. 

Acidum Aceticum Glaciale — Acidi Acetici Glacialis — Glacial Acetic Acid. 

— Used as a caustic. 

Acidum Citricum— Acidi Citrici— Citric Acid. 

U. S. P. 

Definition. — A tribasic organic acid, C 3 H 4 (OH) (COOH) 3 -f- H 2 0, usually pre- 
pared from the juice of limes or lemons. 

Description and Properties. — Colorless, translucent, right-rhombic prisms; 



484 A TEXT-BOOK OF MA TERIA MEDICA. 

odorless, having an agreeable, purely acid taste ; efflorescent in warm air and deliques- 
cent when exposed to moist air. Soluble in 0.54 part of water, in 1.55 parts of alcohol, in 
about 0.4 part of boiling water, and in 1.43 parts of boiling alcohol. 

Dose. — 5-20 grains (0.3-1.25 Gm.) [7^ grains (0.5 Gm.), U. S. P.]. 

Official Preparation. 

Synipus Acidi Citrici — Syrupi Acidi Citrici — Syrup of Citric Acid. — Dose, 
2-8 fluidrams (7.4-30. Cc.) (0.1 per cent.). 



Acidum Tartaricum— Acidi Tartarici— Tartaric 
Acid. U. S. JP. 

Definition. — A dibasic organic acid, C„H 2 (OH) 2 (COOH) 2 , usually prepared from 
argol. 

Description and Properties. — Colorless, translucent, monoclinic prisms, or 
crystalline crusts, or a white powder ; odorless, having a purely acid taste, and per- 
manent in air. Soluble in about 0.71 part of water and in 1.67 parts of alcohol ; also 
in about 0.5 part of boiling water, and in 0.2 part of boiling alcohol. 

Dose. — 10-30 grains (0.6-2.0 Gm.) [7^ grains (0.5 Gm.), U. S. P.]. 

Antagonists and Incompatibles. — Alkalies are chemically in- 
compatible with the vegetable acids. With the alkaline, earthy, and 
metallic bases vegetable acids unite to form salts, the acetates of 
which are all soluble. 

Synergists. — Alkalies, and, under certain circumstances, mineral 
acids and the digestive ferments. 

Physiological Action. — Externally and Locally. — The vege- 
table acids have about the same action externally and locally as the 
diluted mineral acids, not caustic but irritant, acetic acid being the 
most powerful and citric acid the weakest. 

Internally. — Digestive System. — Their action on the salivary and 
gastric glands is similar to that of the mineral acids. Their influ- 
ence upon the stomach is not so marked as that of hydrochloric 
acid, though the secretions from the intestinal glands are more 
augmented by vegetable than by mineral acids. Too large or con- 
tinued doses of the vegetable acids produce flatulence and abdom- 
inal pain, and may even occasion diarrhea or enteritis. 

Circulatory System. — Large doses retard and weaken the pulse. 
The oxidizable organic acids increase the alkalinity of the blood 
and of the urine, thus differing from the mineral acids. 

Absorption and Elimination. — As stated, vetetable acids unite 
with the alkalies to form salts, as such entering the circulation. 
They are eliminated chiefly by the kidneys, increasing the excre- 
tion of both water and solids. Elimination also takes place to a 
considerable extent by the intestinal canal. 

Poisoning. — Their toxic effects vary widely. Some are non- 
toxic — citric ; tartaric is slightly toxic in very large doses ; oxalic 
is a severe poison, the symptoms of which differ in many respects 
from those of poisoning by the mineral acids. The most import- 
ant symptoms are : Either gastro-intestinal irritation with profound 
collapse or, at times, there is simple collapse with weak heart, 



A CIDS— ALKALIES— SAL TS. 485 

stupor, unconsciousness, and death, due to central paralysis. 
Poisoning by potassium oxalate adds the effects of potassium, and 
there is more profound cardiac collapse. 

Treatment of Poisoning. — Mild alkalies control the action of the 
milder organic acids. In oxalic-acid poisoning — suicidal, or poison- 
ing by potassium oxalate, accidentally eating of " sour grass," rhu- 
barb, rumex, or sorrel oxalis in any form — use gastric lavage, fol- 
lowed by magnesia or chalk, well diluted. Cardiac and respira- 
tory stimulants are necessary. Small doses of opium and strych- 
nine and atropine may be of service. Glacial acetic acid is a pow- 
erful corrosive acid. 

Therapeutics. — Externally and Locally. — All the vegetable acids 
here described are irritant, more or less antiseptic, and hemostatic, 
acetic acid being the most powerful antiseptic of the three. Engle- 
mann regards acetic acid as superior to mercuric chloride as a disin- 
fectant in obstetrical practice, employing a solution of from 3 to 5 
per cent, for this purpose. A diluted solution is a valuable injec- 
tion in gonorrhea of the female. Glacial acetic and trichloracetic 
acids are powerful caustics, and are much used to dissolve horny 
growths ', warts, corns, etc. 

The most important use of acetic acid is in the treatment of 
certain parasitic ski?i diseases, probably no remedy excelling it in 
cases of ringworm and pityriasis. Diluted acetic acid, or vinegar, 
is an efficient gargle in simple sore throat and the last stage of 
angince of exanthemata, as well as a valuable hemostatic, espe- 
cially in epistaxis. 

Citric acid is but little used locally, although solutions have 
been employed with some success to relieve the itching and sting- 
ing of " prickly heat " and urticaria. A sponge-bath of lemon 
and water is a grateful and efficient means of reducing temperature 
and checking excessive sweating in disease. 

Tartaric acid has been used by Potter as an application to 
the throat in diphtheria, the effect being to convert the membrane 
into a gelatinous mass, which is more easily expelled. 

Internally. — Acetic acid is little used internally. Citric acid, 
however, in the form of a lemonade, is a refreshing refrigerant 
drink in fevers, while a similar hot lemonade taken at bedtime is a 
valuable and agreeable means of aborting a " cold." Lemon- or 
lime-juice is useful in scurvy, being unquestionably the most efficient 
remedy for the disease. 

It is well known by the laity that eating lemons increases the 
functional activity of the liver. Lemons and citric acid, there- 
fore, are efficient remedies in relieving attacks of biliousness and 
catarrhal jaundice , and they even appear to counteract the effects 
of malaria. Lemon-juice is an old and esteemed remedy in acute 
rheumatism. Citric acid is an invaluable adjunct in rendering the 
urine bland in gonorrheal or other forms of cystitis. 

Vegetable acids are used for the same disorders of the digestive 
tract as mineral acids, although not so efficient as the latter, espe- 



486 A TEXT-BOOK OF MA TERIA MEDICA. 

daily hydrochloric acid. Much of the benefit derived from sour 
table-wines is due to the fruit-acids they contain. 

Contraindications. — Ordinarily the same as for mineral acids. 
It is a matter of observation that nursing mothers may produce a 
troublesome diarrhea in the infant by partaking too freely of vinegar 
or acid fruits. 

Administration. — A solution of citric acid may be made of 
about the acidity of lemon-juice by dissolving 570 grains (36.93 
Gm.) in 1 pint (473.17 Cc.) of distilled water. Vegetable acids 
when taken internally should be mixed with, or dissolved in, water 
and diluted and sweetened, that they may be pleasant to the taste 
and acceptable to the stomach. 

HYDROCYANIC ACID AND CYANIDES. 

Acidum Hydrocyanicum Dilutum— Acidi Hydrocy- 
anici Diluti— Diluted Hydrocyanic Acid. U. S. P. 

Definition. — A liquid composed of not less than 2 per cent, by weight of abso- 
lute hydrocyanic acid, HCN, and about 98 per cent, of water. 

Description. — A colorless liquid with characteristic odor, extremely poisonous. 
Dose. — 1% minims (o. 1 Cc), U. S. P. 

Potassii Cyanidum— Potassii Cyanidi— Potassium 
Cyanide. JJ. S. I>. 

Origin. — Prepared by heating in an iron crucible a mixture of exsiccated potas- 
sium ferrocyanide 8 parts and potassium carbonate 3 parts until effervescence ceases. 

Description and Properties. — White, opaque, amorphous pieces, or a 
white, granular powder, odorless when perfectly dry, but in moist air exhaling the odor 
of hydrocyanic acid. The taste is sharp and somewhat alkaline, but should be tested 
with great care, as the salt is very poisonous. In moist air it deliquesces ; soluble in 
about 2 parts of water and sparingly soluble in alcohol. Potassium cyanide should 
be kept in well-stoppered bottles. 

Dose. — ^-\ grain (0.004-0.008 Gm. ). 

Physiological and Toxicological Action. — On the skin dilute 
hydrocyanic acid has little action — more concentrated solutions 
cause numbness. On mucous membranes it causes a sensation of 
warmth, in the mouth salivation occurs, due to its acrid burning 
and penetrating taste and odor. Numbness follows from the anes- 
thetic action of the acid. On the mucous membrane of the stomach 
it has a similar action. 

Nervous System. — In small doses it may cause a sense of giddi- 
ness with temporary nausea and faintness. In toxic doses, how- 
ever, it has a very pronounced action. The medullary centers are 
primarily involved, followed by other nervous centers. The respi- 
ratory center is primarily stimulated, rendering the respiratory 
movements fuller and more rapid. Convulsive respiratory move- 
ments and dyspnea supervene on larger doses — the rhythm being 
also influenced by the onset of generalized convulsive seizures 
which are characteristic of poisoning. Paralysis of respiration 
follows. 



A CIDS— ALKALIES— SAL TS. 487 

Consciousness is in the early stages clouded, headache and 
mental confusion are present, and complete unconsciousness soon 
develops if the dosage is large. Vasomotor and muscle paresis is 
later evident from the loss of blood-pressure and involuntary fecal 
and urinary evacuations. 

Circulatory System. — The heart is less affected than the medul- 
lary centers. The primary medullary irritation causes vagus stimu- 
lation and a slightly slowed heart — the blood-pressure rising at the 
same time ; but on the advent of the medullary paralysis the pressure 
falls and the heart beats faster ; but the oncoming of a true muscle- 
poisoning prevents it from beating very rapidly. Heart paralysis 
is secondary to medullary paralysis. 

Metabolism. — Hydrocyanic acid has a marked activity in intra- 
cellular metabolism. It seems to lock up, as it were, the vital proc- 
esses — retarding them or completely destroying them, according 
to the grade of poisoning. It seems to prevent oxygen-absorption 
particularly. The venous blood retains its bright-red color be- 
cause of the lack of reduction of the oxyhemoglobin. 

Cyanide of potassium differs from hydrocyanic acid in no essen- 
tial particulars. 

BORIC ACID AND BORATES. 

Acidum Boricum— Acidi Borici— Boric Acid. 
U. S. P. 

(Boracic Acid.) 

Origin. — Found native in Northern Tuscany. It may be prepared by the action 
of hydrochloric acid on borax, filtration, and recrystallization. 

Description and Properties. — Transparent, colorless scales, of a somewhat 
pearly luster, or, when in perfect crystals, six-sided, triclinic plates, slightly unctuous 
to the touch, odorless, of a faintly bitterish taste, permanent in the air. Soluble in 
25.6 parts of water, 15 parts of alcohol, and 10 parts of glycerin. The addition of 
hydrochloric acid increases its solubility in water. 

Dose. — 5-15 grains (0.32-1.0 Gm.). 

Official Preparations. 

Glyceritum Boroglycerini — Glyceriti Boroglycerini — Glycerite of Borogly- 
cerin (Glycerite of Glyceryl Borate — Solution of Boroglyceride). — Boric 
acid, 310; glycerin, to 1000. For external use. 

Unguentum Acidi Borici — Unguenti Acidi Borici — Ointment of Boric Acid. 
— A 10 per cent, ointment made with paraffin and white petrolatum. Similar to the 
Unguentum Acidi Borici of the British and German Pharmacopoeias. 

Liquor Antisepticus — Liquoris Antisepticus — Antiseptic Solution. — A solu- 
tion of mild aromatics and antiseptics similar to certain commercial preparations. 
Among other things it contains about 2 per cent, of boric acid, o. 1 per cent, each of 
benzoic acid and thymol, and 25 per cent, of alcohol. 

Dose. — Average dose : I fiuidram (4 Cc), U. S. P. 

Sodii Boras— Sodii Boratis— Sodium Borate. 

U. S. JR. 

(Borax.) 

Origin. — Prepared by boiling together solutions of boric acid and sodium car- 
bonate, the borax crystallizing out. It is also found in a native state on the shores of 
certain lakes and as a crystalline deposit in the borax lake of California. 



A TEXT-BOOK OF MA TERIA MEDICA. 

Description and Properties. — Colorless, transparent, monoclinic prisms, or 
a white powder, inodorous, and of a sweetish, alkaline taste ; slightly efflorescent in 
warm, dry air ; soluble in 16 parts of water and in I part of glycerin; insoluble in 
alcohol. 

Dose. — 5-30 grains (0.32-2.0 Gm. ). 

Antagonists and Incompatibles. — The incompatibles of borax 
are the acids and metallic salts. Morphine and cocaine are pre- 
cipitated from solutions by borax. Boric acid is also incompat- 
ible with the carbonates and bicarbonates, and with the alkaline, 
earthy, and metallic bases. 

Synergists. — The action of borax is enhanced by alkalies and 
substances promoting waste ; that of boric acid, by the anti- 
septics. 

Physiological Action. — Externally and Locally. — Borax is ab- 
sorbent, protectant, sedative, and antiseptic. Applied to the un- 
broken skin, it acts upon the epidermis as a soap. By removing 
the stimulus to secretion and lessening irritation borax checks the 
secretion of the salivary glands. 

Boric acid possesses properties similar to those of borax, 
although more of an antiseptic and antipruritic. It has also an 
exsiccant and detergent influence. It is a very weak acid and 
shows little hydrogen ion action. 

Internally. — In a general way the action of borax is analogous 
to that of the alkalies. It is refrigerant and diuretic, and by its 
immediate action upon the womb serves as an emmenagogue, large 
doses contracting the uterine muscles and acting as an ecbolic. 
Excessive doses of either of these drugs act as gastro-intestinal 
irritants. 

Boric acid, though stronger, resembles borax in its action. Both 
substances, especially boric acid, retard the action of saliva upon 
starch, increasing that of the pancreatic juice upon albuminous 
substances, and increase gastric digestion. Immoderate doses of 
boric acid check gastric digestion. 

The drug is a moderate antipyretic, and when injected in large 
amounts into the circulation may occasion paralysis of the motor 
nerves and muscles. 

Absorption and Elimination. — It is eliminated by the saliva, per- 
spiration, feces, and urine, the latter being, according to Gies, dimin- 
ished in quantity. The amount of nitrogen and solid matter ex- 
creted with the feces is also increased, as well as the elimination 
of urea in the urine. 

Untoward Action. — Boric acid absorbed from boric-acid dress- 
ings has occasioned the following untoward symptoms ; frequent 
desire to micturate; nausea, vomiting, and other gastric disturb- 
ances ; small, weak pulse ; sleeplessness, muscular weakness, dim- 
ness of sight, depression, headache, hiccough, and various cutaneous 
eruptions, particularly eczema and psoriasis. Some of the untoward 
symptoms have seemed to arise in people who ate food preserved 
by borax (see Wiley's Report, U. S. Bureau of Chemistry). 



A CIDS— ALKALIES— SAL TS. 489 

Poisoning. — The symptoms of poisoning are analogous to those 
just described. 

Treatment of Poisoning. — The treatment of poisoning should 
be symptomatic ; stimulants, morphine, etc., being employed. 

Therapeutics. — Externally and Locally. — Both borax and boric 
acids are valuable as local remedies in the treatment of many dis- 
orders of the ear, nose, and throat, such as acute and chronic nasal 
catarrh, pharyngitis, gingivitis, and acute hoarseness. 

An efficient domestic remedy in aphthcz affecting the mouths of 
nursing children is a mixture of borax and honey. 

An invaluable antiseptic application in acute conjunctivitis is a 
saturated solution of boric acid, and the dry powder serves as 
an efficient remedy in otorrhea. 

Leukorrhea, gonorrhea, and chronic cystitis are greatly benefited 
by solutions, in various strengths, of either or both of these drugs. 
Sir James Simpson recommends a solution of borax, 5-10 grains 
(0.32-0.6 Gm.) to 1 ounce (30.0 Gc.) of hot water, for the eruption 
occurring on the mucous membrane of the vulva in young girls. 

It is invaluable as a bland, unirritating antiseptic in general 
surgery, and in diseases of the eye, ear, nose, throat, and skin. 

It should be borne in mind, however, that the antibacterial 
action of these compounds is very slight, and only concentrated 
solutions are of any avail. In otitis media it can be used in alco- 
holic solution, the evaporation of the alcohol leaving the pure sub- 
stance behind. 

Internally. — Borax is used internally more than boric acid. 
While in epilepsy inferior to the bromides, there are cases un- 
influenced by the latter remedies which respond favorably to 
borax. 

Its value in epilepsy is very questionable unless one ascribes it 
to its antibacterial action in the intestines, thus limiting putrefactive 
processes in this viscus. 

In chronic cystitis 5 -grain (0.3 Gm.) doses of boric acid three 
times a day are useful 

These drugs have been used internally in the summer diarrhea 
of children. 

Administration. — The remedies may be given in capsules or 
solution. The taste of borax may be disguised by coffee, syrup of 
orange, or aromatic elixir of licorice, the drug not being admin- 
istered with glycerin, lest an acid reaction occur. 

The newly introduced liquor antisepticus is a convenient mode 
to prescribe a cheap antiseptic lotion. 

Potassii Dichromas— Potassii Dichromatis— Potas- 
sium Dichromate. U. S. JP. 

Origin. — Prepared by roasting in a reverberatory furnace potassium carbonate and 
chrome-iron ore, with the addition of lime or chalk to prevent fusion. The potassium 
dichromate formed is separated by crystallization from its solution in water acidulated 
with sulphuric acid. 



49° A TEXT-BOOK OF MA TERIA MEDICA. 

Description and Properties. — Large orange-red, transparent triclinic prisms 
or four-sided tables, odorless, and having a bitter, metallic taste. Permanent in the 
air ; soluble in 19 parts of water ; insoluble in alcohol. 

Dose. — Tthr -1 g ram (0.0006-0.06 Gm.) [^ grain (0.01 Gm.), U. S. P.]. 

Antagonists and Incompatibles. — Potassium dichromate is in- 
compatible with soluble salts of silver, mercury, and lead, and with 
liquor potassae, liquor sodae, and ammonia water. 

Synergists. — Agents promoting waste, antiseptics, and caustics. 

Physiological Action. — Externally and Locally. — In substance 
potassium dichromate is an irritant caustic, and, according to Miquel, 
an antiseptic in the proportion of 1 to 909. 

Internally. — Its action is nearly identical with that of potassium 
chlorate, with the additional properties of an expectorant, emetic, 
and mild alterative. 

Poisoning and treatment of poisoning do not differ essentially 
from those of potassium chlorate. 

Therapeutics. — Externally and Locally. — Potassium dichromate 
is used as a caustic for warts, corns, chancres, chancroids, mucous 
patches, etc., and is also of considerable value as a gargle in 
pharyngitis. 

Internally. — Frazer has recently recommended this drug in the 
treatment of dyspepsia and gastric ttlcer, claiming that the pain, 
nausea, vomiting, and tenderness may be readily allayed by doses 
of ■£% to jr grain (0.005-0.01 Gm.), taken upon an empty stomach 
three times a day. In acute gastric ulcer he has perceived no 
benefit so far as its effect upon the hemorrhage is concerned, the 
most desirable action of the drug in the latter condition being 
derived from its antiseptic and analgesic influence. 

Potassium dichromate, in doses of T ^ grain (0.0006 Gm.) every 
hour or two, has proven of service in aphonia and hoarseness due to 
excessive action of the vocal cords or resulting from an acute cold. 

Potassii Chloras— Potassii Chloratis— Potassium 
Chlorate. U. S. JP. 

Origin. — Prepared by passing chlorine into a mixture of potassium carbonate and 
slaked lime. By subsequent boiling in water the chlorate separates by crystallization. 

Description and Properties. — Colorless, lustrous, monoclinic prisms or 
plates, or a white powder, odorless, and having a cooling, saline taste; permanent in 
the air; soluble in 16 parts of water ; insoluble in absolute alcohol. Potassium chlorate 
should be kept in glass-stoppered bottles. Great caution should be observed 'in handling 
the salt, since dangerous explosions are liable to occur when it is mixed with organic 
matters — cork, tannic acid, sugar, etc. — or with sulphur, antimony sulphide, phosphorus, 
or other easily oxidizable substance, or upon being either heated directly or subjected 
to trituration or concussion. 

Dose. — 3-20 grains (0.2-1.3 Gm. ) [4 grains (0.25 Gm.), U. S. P.]. 

Official Preparation. 

Trochisci Potassii Chloratis — Trochiscos (ace.) Potassii Chloratis — 
Troches of Potassium Chlorate. — Each troche contains 2.y z grains (0.15 Gm.). 
Dose, I to 4 troches. 



ACIDS— ALKALIES—SALTS. 49 1 

Antagonists and Incompatibles. — In addition to those sub- 
stances mentioned with which potassium chlorate forms explosive 
compounds, mixture with glycerin and the hypophosphites is liable 
to produce similar dangerous results. 

Synergists. — Agents promoting waste increase the activity of 
the drug. 

Physiological Action. — Externally and Locally. — It is slightly 
detergent and stimulant, antiseptic and astringent, being irritant 
when applied in concentrated solution to ulcerated surfaces. 

Internally. — Digestive System. — Beyond the cool, salty, and per- 
sistent taste medicinal doses have little effect ; poisonous doses 
excite violent gastro-intestinal irritation, nausea, bloody vomiting, 
diarrhea, and jaundice. 

Nervous System. — Medicinal doses are inert. Toxic doses may 
produce delirium and death, preceded by coma or convulsions. 

Circulatory System. — Small doses of potassium chlorate tend 
to depress and subsequently raise arterial tension, accelerating the 
pulse ; large doses lower arterial pressure alarmingly ; toxic doses 
convert the hemoglobin of the blood into methemoglobin, the dis- 
organized fluid appearing in the urine. Postmortem lesions are — 
enlargement of the liver, spleen, and kidneys, with evidences of 
marked inflammation over the whole intestinal tract. 

Respiratory System. — Large doses act as a depressant to the 
respiratory apparatus. 

Absorption and Elimination. — The drug is absorbed with con- 
siderable rapidity, being chiefly eliminated by the salivary glands 
unchanged. The drug does not increase the urinary flow, large 
doses, on the contrary, tending to suppress it. 

Temperature. — Unaffected by medicinal doses, but lowered by 
toxic amounts. 

Untoward Action. — Small doses of potassium chlorate seldom 
produce untoward symptoms, although in rare instances eruptions 
of an erythematous, papular, or vesicular nature have followed the 
use of the drug. Digestive disturbances occasionally ensue, as 
well as pain in the region of the kidneys and albuminuria. 

Poisoning. — In a few recorded cases of poisoning there were 
observed a continuous sensation of choking, excessive thirst, per- 
sistent vomiting, pain in the abdomen and renal tract, and violent 
hiccough. Accompanying symptoms were — a small and rapid 
pulse and faintness, while the urine was albuminous and diminished 
in quantity; epistaxis was present; the eyes and lips were cyanotic, 
and the skin slightly jaundiced and markedly anemic ; the liver and 
spleen were slightly enlarged ; and there were alternating sensations 
of cold and heat, with drowsiness, ending in coma and death. 

Treatment of Poisoning. — The stomach should be emptied as 
quickly as possible and demulcents administered. The patient 
should be treated symptomatically, and it may be advisable to 
practice venesection, followed by transfusion of blood, as suggested 
by Landerer. 



492 A TEXT-BOOK OF MATERIA MEDICA. 

Therapeutics. — Externally and Locally. — A solution of this 
drug has been applied with some success in foul ulcers and moist 
eczema. Like the potassium permanganate, it has been employed 
in various diseases of the nose and throat, and is especially service- 
able in ptyalism and aphthous ulceration. As a remedy for syphilitic 
mucous patches and herpes of the buccal cavity it is of considerable 
value. It is more efficient in acute than in chronic pharyngitis. 

It possesses marked cicatrizing power, advantage of which 
property has been taken in the treatment of phagedenic sores, the 
powdered drug being used for this purpose. It is thought that 
enemas of potassium chlorate solution favor the healing of rectal 
ulcers. 

Internally. — As a remedial agent this drug has not met with the 
success prophesied by many physicians. It has found some advo- 
cates as a genito-urinary antiseptic and as a remedy in typhoid 
fever. 

Yet, notwithstanding the extravagant, though isolated, reports 
concerning the great value of the drug, its utility has not been 
universally recognized ; indeed, so good an authority as Marchand 
declares that " chlorate of potassium should be entirely rejected in 
practice, and particularly in the treatment of children." 

Administration. — It may be given in the form of troches, 
powder, tablets, or a solution, an agreeable means of administra- 
tion being in aerated water. Owing to its tendency to decomposi- 
tion when combined with other substances, the drug should be 
prescribed alone. 



DRUGS ACTING CHIEFLY ON THE GASTRO- 
INTESTINAL ORGANS. 

BITTERS. 

SIMPLE BITTERS. 

Quassia— Quassiae— Quassia. U. S. P. 

Definition. — The wood of Picrasma excelsa (Swz.) Plancon, known commercially 
as Jamaica quassia or of Quassia amara L., known commercially as Surinam quassia. 

Description and Properties. — In the shops it is usually met with in the form 
of chips or raspings of a yellowish-white color, or in billets (Surinam). Quassia con- 
tains two bitter principles — quassin and picrasmin. It contains no tannin. 

Dose.— 10-30 grains (0.6-2.0 Gm.) [7^ grains (0.55 Gm.), U. S. P.]. 

Official Preparations. 

Extractum Quassiae — Extracti Quassiae — Extract of Quassia. — Dose, 1-3 
grains (0.065-0.2 Gm.). 

Fluidextractum Quassiae — Fluidextracti Quassiae — Fluidextract of Quassia. 
— Dose, 10-30 minims (0.6-2.0 Cc.) [Average dose, 8 minims (0.5 Cc), U. S. P.], 

Tinctura Quassiae — Tincturae Quassiae — Tincture of Quassia. — Dose, 30 
minims (2 Cc). 

Gentiana— Gentianae— Gentian. U. S. P. 

Origin. — The dried rhizome and roots of Gentiana lutea L., a plant from 2 to 3 
feet high, indigenous in the mountainous portions of Central Europe. 

Description and Properties. — It appears in nearly cylindrical pieces or 
longitudinal slices about I inch (25 Mm.) thick, the upper portion closely annulate, 
the lower longitudinally wrinkled ; externally deep yellowish-brown; internally lighter ; 
somewhat flexible and rather thick, separated from the subspongiose medulla by a 
black cambium line. Odor peculiar, faint, stronger when moistened; taste sweetish and 
persistently bitter. Gentian contains a bitter glycoside (gentiopicrin) and also gentisic 
acid, to which its yellow color is due. It contains about 15 per cent, of glucose, but 
no starch nor pure tannin. 

Dose. — 5-30 grains (0.3-20 Gm.) [15 grains (I Gm.), U. S. P.], 

Official Preparations. 

Extractum Gentianae — Extracti Gentianae — Extract of Gentian. — Dose, 2-10 
grains (0.12-0.6 Gm.) [4 grains (0.25 Gm.), U. S. P.]. 

Fluidextractum Gentianae — Fluidextracti Gentianae — Fluidextract of 
Gentian. — Dose, 5-30 minims (0.3-2.0 Cc. ) [15 minims (1 Cc), U. S. P.]. 

Tinctura Gentianae Composita — Tincturae Gentianae Compositae — Com- 
pound Tincture of Gentian. — Dose, 1-2 fluidrachms (4.0-8. oCc.) [1 fluidram (4CC.), 
U. S. P.]. 10 per cent, with orange peel and cardamom. 

Calumba— Calumbae— Calumba. 77. S. jP. 

(COLUMBO.) 

Origin. — The dried root of Jateorhiza palmata (Lam.) Miers., a plant native to 
the forests of Eastern Africa and Madagascar, and cultivated in the East Indies. * 

Description and Properties. — Nearly circular disks I to 2 inches (25-50 

493 



494 A TEXT-BOOK OF MATERIA MEDICA. 

Mm.) in diameter and ^ to )/ z inch (6-12 Mm.) thick. Externally greenish-brown and 
wrinkled; internally yellowish or grayish-yellow ; depressed in the center, with a few 
interrupted circles of projecting wood-bundles ; distinctly radiate in the outer portion ; 
fracture short, mealy ; odor slight ; taste mucilaginous, slightly aromatic, very bitter. 
It contains a bitter crystalline principle (calumbin, calumbic acid, berberine) and starch. 
No tannin is present. 

Dose. — 10-60 grains (0.6-4.0 Gm.) [30 grains (2 Gm.), U. S. P. 

Official Preparations. 

Fluidextractum Calumbae — Fluidextracti Calumbae— Fluidextract of Ca- 
lumba. — Dose, 10-60 minims (0.6-4.0 Cc.) [30 minims (2 Cc), U. S. P.]. 

Tinctura Calumbae — Tincturae Calumbae — Tincture of Calumba (20 per 
cent.). — Dose, 1-4 fluidrams (4.0-15.0 Cc.) [1 fluidram (4 Cc), U. S. P.]. 

Calendula— Calendulae— Calendula. V. S. JP. 

(Marigold.) 

Origin. — The dried ligulate florets of Calendula officinalis L., an annual plant, 
a native of the Levant and Europe, frequently cultivated as a garden ornament. 

Description and Properties. — Florets about y z inch (12 Mm.) long, linear 
and strap-shaped, delicately veined longitudinally, yellow or orange-colored, three- 
toothed at the apex, the short, hairy tube enclosing the remnants of a filiform style 
elongately cleft. Odor slight and somewhat heavy ; taste rather bitter and faintly 
saline. It contains a peculiar gummy principle, calendulin, a bitter constituent, and a 
trace of volatile oil. 

Dose. — 5-30 grains (0.3-2.0 Gm.) [15 grains (1 Gm.),U. S. P.]. 

Official Preparation. 

Tinctura Calendulae — Tincturae Calendulae — Tincture of Calendula (20 
per cent.). Dose, 15-60 minims ( 1. 0-4.0 Cc). 

Chirata— Chiratae— Chirata. U. S. P. 

Origin. — The dried plant Swerlia Chirayita (Rox. ) Hamilton, an annual, native 
to Northern India. 

Description and Properties. — Chirata, as found in the shops, consists of 
short sections of the stem and branches pressed and split, brown or dark-purple in 
color, and mixed with a few leaves and flowers. It contains a very bitter yellow 
principle, a hygroscopic glycoside (chiratin), a bitter syrupy liquid {ophelic acid), a 
resin, coloring-matter, etc. No tannin is present. 

Dose. — 5-20 grains (0.3-1.3 Gm.) [15 grains (1 Gm. ), U. S. P.]. 

Official Preparation. 

Fluidextractum Chiratae — Fluidextracti Chiratae— Fluidextract of Chirata. 
— Dose, 5-20 minims (0.3-1.3 Cc.) [15 minims (1 Cc), U. S. P.]. 

AROMATIC BITTERS. 

Anthemis— Anthemidis— Anthemis. TJ. S. JP. 

(Chamomile.) 

Origin. — The dried flower-heads of Anthe?nis nobilis L., a low perennial plant 
indigenous in Southern and Western Europe. 

Description and Properties. — Heads subglobular, about ^ inch (2 Cm.) 
broad, consisting of an imbricated involucre and numerous white, strap-shaped, three- 
toothed florets, and a few, if any, yellow tubular disk-florets, inserted upon a chaffy, 
conical, solid receptacle ; of a strong, agreeable odor and an aromatic, bitter taste. 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 495 

Anthemis contains a bitter principle, a pale-blue or yellowish-brown volatile oil, and 
a trace of tannin, together with other unimportant constituents. 

Dose. — 15-60 grains (1.0-4.0 Gm.) [30 grains (2 Gm.), U. S. P.], in infusion 
or fluidextract. 

Prunus Virginiana— Pruni Virginianae— Wild 
Cherry. V. S. JP. 

Origin. — The bark of Prunus serotina Ehr, which should be collected in 
autumn. 

Description and Properties. — It is met with in curved pieces or irregular 
fragments ^ inch (2 Mm.) or more thick ; outer surface greenish-brown or yellowish- 
brown, smooth and somewhat glossy, marked with transverse scars. If the bark is 
collected from the old wood and deprived of the corky layer, the outer surface is nut- 
brown and uneven ; inner surface somewhat striate or fissured. Upon maceration in 
water it develops a distinct bitter-almond odor. Taste astringent, aromatic, and bitter. 
It contains tannin, resin, a glycoside — amygdalin (laurocerasin), and a ferment — 
emulsin. In the presence of water the glycoside is broken up into hydrocyanic acid and 
a volatile oil. Benzaldehyd results also from the ferment action. Temperature above 
160 F. destroys the action of the ferment. 

Dose. — ]/ 2 -\ dram (2.0-4.0 Gm.) [30 grains (2 Gm.), U. S. P.]. 

Official Preparations. 

Fluidextractum Pruni Virginianae — Fluidextracti Pruni Virginianae — Fluid- 
extract of Wild Cherry. — Dose, 30-60 minims (2.0-4.0 Cc. ) [30 minims (2 Cc. ), 

Infusum Pruni Virginianae — Infusi Pruni Virginianae — Infusion of Wild 
Cherry. — Dose, 1-2 fluidounces (30.0-60.0 Cc.) [2 ounces (60 Cc), U. S. P.]. 

Syrupus Pruni Virginianae — Syrupi Pruni Virginianae — Syrup of Wild 
Cherry.— Dose, 2-4 fluidrams (8.0-15.0 Cc.) [i dram (4 Cc), U. S. P.]. 

Serpentaria— Serpentariae— Serpentaria. U. S. JP. 

(Virginia Snakeroot. ) 

Origin. — The dried rhizome and root of Aristolochia Serpentaria L. (Virginia 
Serpentaria) or Aristolochia reticulata Nutt. (Texas Serpentaria), perennial herbs 
indigenous in the United States. 

Description and Properties. — The rhizome of Virginia serpentaria is about 
1 inch (25 Mm.) long, thin, curved ; on the upper side with approximate, short stem- 
bases; on the lower side with numerous thin, branching roots about 4 inches (10 Cm) 
long ; dull yellowish-brown, internally whitish ; the wood-rays of the rhizome are 
longest on the lower side ; odor aromatic, camphoraceous ; taste warm, bitterish, and 
camphoraceous. It contains ]/ 2 per cent, of volatile oil, a bitterish principle aristo- 
lochin, tannin, resin, starch, etc. The roots of Aristolochia reticulata are coarser, 
longer, and less interlaced than those of Aristolochia Serpentaria. 

Dose. — 10-30 grains (0.6-2.0 Gm.) [15 grains (1 Gm.), U. S. P.]. 

Official Preparations. 

Fluidextractum Serpentariae — Fluidextracti Serpentariae — Fluidextract of 
Serpentaria. — Dose, 10-30 minims (0.6-2.0 Cc.) [15 minims (1 Cc), U. S. P.]. 

Tinctura Cinchonae Composita — Tincturae Cinchonae Compositae — Com- 
pound Tincture of Cinchona. — Dose, 1-4 fluidrams (4.0-15.0 Cc.) (2 per cent, of 
serpentaria). 

Tinctura Serpentariae — Tincturae Serpentariae— Tincture of Serpentaria 
(20 per cent.). — Dose, \-2 fluidrams (2.0-8.0 Cc) [1 dram (4 Cc), U. S. P.]. 

Antagonists and Incompatibles. — -The salts of iron, lead, and 
silver are incompatible with gentian and the aromatic bitters, though 
preparations of iron can be given with quassia, calumba, and 
chirata. Boiling water impairs the virtues of wild cherry. 



496 A TEXT-BOOK OF MATERIA MEDICA. 

Synergists. — The digestants, mineral acids, and, under certain 
conditions, alkalies, and the restorative agents generally, aid the 
action of vegetable bitters. 

Physiological Action. — Because of their action in augmenting 
the secretions from the salivary and gastric glands, they aid diges- 
tion and improve nutrition. 

Pure bitters act immediately upon contact ; that is, their 
efficiency is due to their local action upon the mucous membrane 
of the mouth, tongue, and esophagus. 

Bitters increase the secretion from the salivary glands. This 
effect is produced by stimulating the ends of the nerves of taste 
distributed in the mucous membrane of the mouth, from which 
nerves the impression is conveyed to the center in the medulla, and 
from there transmitted to the vasomotor and secretory nerves 
supplying the salivary glands, increasing their blood-supply and 
activity and at once promoting the secretion of saliva. 

Bitters increase the secretion from the gastric glands. The 
primary action is an augmented flow of gastric juice, caused by 
reflex stimulation from the mouth. It is well known that there 
is an intimate relationship between the stomach and the senses of 
taste and smell. The taste of victuals or the odor of a tempting 
dinner excites the appetite, and, reflexly, the flow of gastric juice, 
similar to the flow of saliva in a dog looking wistfully at a meat- 
stand. Bitters act in a similar manner. The nerves of taste are 
stimulated ; the impression is conveyed to the medulla, and from it 
transmitted not only to the salivary glands, but through the fibers 
of the vagus, increasing the blood-supply to the gastric glands and 
thereby promoting their functional activity. 

Bitters stimulate the peristaltic movements of the stomach by 
reflex action. The sensory nerves in the mucous membrane are 
irritated, and an impression is conveyed by them to Auerbach's 
plexus between the muscles in the walls of the stomach, from 
which plexus, or ganglion, the influence is transmitted to the mus- 
cles themselves, causing increased activity or peristalsis. 

Another method by which peristalsis is stimulated occurs when 
the impression is conveyed by the sensory nerves directly to the 
center in the medulla, and from there through the motor fibers of 
the vagus to Auerbach's plexus, affecting the muscles in the man- 
ner just described. 

Bitters augment absorption by increasing the blood-supply 
to the mucous membrane of the stomach. It is a physiological 
fact that the larger the blood-supply passing through the blood- 
vessels, and the greater the amount of lymph conveyed through 
the lymph-channels, the more rapid the absorption. 

Bitters also induce leukocytosis. Their action as antiseptics 
is secondary to the increase of the gastric juice, digestion being a 
physiological fermentative process, forming a contraindication to 
the administration of bitters during active digestion. 

Therapeutics. — Externally and Locally. — The tincture of calen- 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 497 

dula is recommended by many physicians as an external appli- 
cation for contusions, sprains, etc., although not so efficient as 
tincture of arnica. The drug has been used topically in chronic 
pharyngitis. 

Internally. — The simple bitters are peculiarly useful in atonic 
and fermentative dyspepsia, cliro7iic gastric catarrh, and as a tonic 
in convalescence from acute disease, in malarial fever, and in the 
anorexia following it. 

Infusion of quassia is a most efficacious injection to destroy 
seat-worms (Oxyuris vermicidaris), the infusion being injected into 
the rectum, which has been previously washed out with soap and 
water and cleared of mucus by salines. 

The aromatic bitters are used to stimulate the appetite and im- 
prove the condition of the digestive apparatus. The simple bitters 
are similarly used, but the former possess more stimulating and 
tonic properties, owing to their volatile and astringent constituents. 
Chamomile, in addition to its action as a stimulant to the digestion, 
has been employed with benefit in delirium tremens and as an em- 
meuagogue, while in the form of hot poultices chamomile flowers 
serve as an efficient application for local pains. 

Wild cherry might not inaptly be called a sedative tonic, its 
peculiarly bitter, yet not unpleasant taste causing it to be well toler- 
ated by the stomach, and rendering it one of the best stomachic 
tonics, especially during convalescence, when its sedative action 
upon the heart allays febrile and cardiac excitement. The syrup 
of wild cherry is a common ingredient of " cough-syrups." It is 
thought to quiet the cough and allay the irritability of the nervous 
system in bronchitis and phthisis — probably owing to the hydro- 
cyanic acid which it contains. 

Serpentaria is considered an efficient expectorant in pneumonia 
and capillary bronchitis. Next to its use as a stomachic its chief 
value seems to be as a stimulant in typhus and typhoid fevers, the 
compound tincture of cinchona being a most excellent remedy in 
the low forms of typhoid. Bitter orange is widely employed as a 
pleasant bitter. Cinchona and nux vomica make most efficient 
bitters. 

Contraindications. — Bitters should not be given when the 
secretion of gastric juice is diminished as the result of organic 
disease. They are contraindicated as stomachics during the 
course of acute disease, as in fevers. When after a reasonable 
time they fail to improve the appetite, they should be discontinued. 
In convalescence from acute disease, when the appetite is vora- 
cious, they are contraindicated. Bitters find their chief usefulness 
in the depressed and hypochondriacal states of fatigue from a vast 
variety of sources, and in which there is loss of appetite. 

Administration. — To improve the appetite bitters should be 
given from one-half to one hour before meals. When necessary to 
use them for a long time, one bitter should be substituted for 
another in the course of every week or two ; otherwise the stomach 



498 A TEXT-BOOK OF MATERIA MEDIC A. 

may rebel at the monotony. Bitters may be given in the form of 
a powder or a solid extract. Ordinarily, however, it is preferable to 
administer a liquid preparation — fluidextract, tincture, or infusion. 
A pleasant method of giving the latter preparation in the case of 
quassia is to allow water to stand overnight or for a few hours in 
a quassia-cup — purchasable at almost any drug store — when the 
water will become impregnated with the bitter principle of the 
quassia. 

DIGESTANTS- 
Pepsinum— Pepsini— Pepsin. 77. S. JP. 

Origin. — A proteolytic ferment or enzyme obtained from the glandular layer of 
fresh stomach of the hog Sus scrofa, and capable of digesting not less than 3000 times 
its own weight of freshly coagulated and disintegrated egg albumin when tested by the 
process given in the United States Pharmacopoeia. 

Description and Properties. — A fine white, or yellowish-white, amorphous 
powder, or thin, pale-yellow, or yellowish, transparent or translucent grains or scales, 
free from offensive odor, and having a mildly acidulous or slightly saline taste, usually 
followed by a suggestion of bitterness. It slowly attracts moisture when exposed to 
the air. Soluble, or for the most part soluble, in about 50 parts of water, with more or 
less opalescence ; more soluble in water acidulated with hydrochloric acid ; insoluble 
in alcohol, ether, or chloroform. Pepsin usually has a slightly acid reaction. It may 
be neutral, but should never be alkaline. 

Dose. — 5-60 grains (0.3-40 Gm.) [4 grains (0.25 Gm.), U. S. P.]. 

Antagonists and Incompatibles. — Tannic and gallic acids are 
incompatibles. Mineral salts, alcohol more than 10 per cent., and 
alkalies precipitate pepsin from solution, the latter two impairing 
its digestive property. 

Synergists. — Diluted hydrochloric acid, in not over T 2 ^- of I per 
cent. , increases its digestive action. 

Physiological Action. — Its only influence seems to be upon the 
digestive system. Pepsin is a typical restorative, being a normal 
constituent of the gastric juice, and in the presence of hydrochloric 
acid digesting the proteid elements of the food, converting them 
into albumoses, and finally into peptones. 

Therapeutics. — Externally and Locally. — Its digestive action is 
utilized to dissolve or digest the false membrane in diphtheria and 
croup. A solution of pepsin has also been injected into the blad- 
der to digest blood-clots. 

Internally. — As a restorative, where there is a lessened secre- 
tion of gastric juice, atonic dyspepsia, apepsia of infants, cancer of 
the stomach, and gastric ulcer, pepsin has proved serviceable. It is 
also employed to favor digestion in convalescence from acute and 
long illness. It is frequently necessary to give pepsin, or " pepton- 
ized milk." in acute dyspeptic diarrhea of infants. 

Administration. — Pepsin should be given in powder or dis- 
solved in glycerin (glycerol of pepsin), or in water acidulated with 
hydrochloric acid, directly after meals. 

The drug should not be given continuously for too long a 
period, lest the function of the stomach become impaired from 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 499 

disuse, the artificial digestion having replaced the natural, normal 
process. 

Unless there be some direct indication for its use, rather than 
give pepsin it is better to stimulate the gastric glands to secrete a 
larger amount of their normal juice, that they may not lie idle, 
and their function be consequently impaired by disuse. Hydro- 
chloric acid administered with pepsin probably promotes glandular 
activity slightly. Often, however, pepsin must be given, and in 
certain patients the stomach is in such a condition that nutrient en- 
emats must be administered. Yet, since the rectum possesses very 
feeble powers of digestion, foods should always be predigested. Sup- 
positories of peptonized meat are frequently used for this purpose. 

Pancreatinum— Pancreatini— Pancreatin. U. S. JP. 

Origin. — A mixture of the enzymes naturally existing in the pancreas of warm- 
blooded animals, usually obtained from the fresh pancreas of the hog or the ox, and 
consisting principally of amylopsin, myopsin, trypsin, and steapsin, and capable of 
converting not less than 25 times its own weight of starch into substances soluble in 
water. 

Description and Properties.— A yellowish, yellowish-white, or grayish 
amorphous powder, odorless, or having a faint, peculiar, not unpleasant odor, and a 
somewhat meat-like taste. Slowly and almost completely soluble in water, insoluble 
in alcohol. 

Pancreatin digests albuminoids and all proteid substances, converts starch into 
sugar, and, when not over twenty-four hours old, aids in the digestion of fats. Pro- 
longed contact with mineral acids renders it inert. 

Dose. — 10-20 grains (0.6-1.2 Gm.) \_*] l /z grains (0.5 Gm.), U. S. P.]. 

Antagonists and Incompatibles. — Strong mineral acids. 

Synergists. — Weak alkalies. 

Physiological Action. — The four ferments which it contains 
render it capable, in either weak alkaline or acid media, of digest- 
ing proteid foods, emulsifying fats and oils, and resolving them 
into fatty acids and glycerin, converting starch into sugar, and 
curdling milk. 

Therapeutics. — Like pepsin, it is used as an artificial agent in 
certain disorders of digestion. 

Administration. — It may be given dry, in powder, capsules, or 
compressed pills, or in solution. It should be administered in 
combination with an alkali, as the activity of pancreatin is de- 
stroyed by acids, and should be given ordinarily from two to four 
hours after meals, when the chyme has entered the intestine. It 
may also be administered immediately after eating or with the food, 
since there is an interval of from fifteen minutes to half an hour 
after the ingestion of food before the stomach-contents are ren- 
dered sufficiently acid by the gastric juice to interfere with the 
activity of the pancreatin. 

For rectal nourishment pancreatin is preferable to pepsin, be- 
cause of its superior action in predigesting food. 

Pankreon is a recently introduced dried mixture of the pancreatic 
emzymes. 



5<X> A TEXT-BOOK OF MA TERIA MEDICA. 

Papain, Papoid, or Papayotin. {Non-official.) 

Origin. — The inspissated juice of the unripe fruit of Carica Papaya. 
Description and Properties. — A whitish, slightly astringent powder, soluble 
in water. 

Dose. — 1-8 grains (0.06-0.5 Gm.). 

Antagonists and Incompatibles. — Tannic and gallic acids. 
Lead salts and alcohol are incompatible with papain. 

Synergists. — The digestive ferments. 

Physiological Action. — In this it resembles pepsin, though dif- 
fering from the latter, as well as from pancreatin, in that it is 
equally active in neutral, alkaline, or acid media. It converts pro- 
teids into soluble peptones, and acts as a stimulant to the gastric 
glands. It converts starch into maltose, and upon false membranes 
acts more energetically than pepsin. It may dissolve intestinal 
worms. 

Therapeutics. — Externally. — The uses of papain are more mani- 
fold than those of the digestive ferments previously mentioned. 
Like pepsin, it has been successfully employed to dissolve false 
membrane in diphtheria and croup. The juice of pineapple, which 
possesses a ferment (bromelin) similar to that of papain, is a val- 
uable domestic remedy in these diseases. Papain has been used 
with some benefit in indurated ezcevia and in syphilitic ulcerations 
of the tongue. It has been highly recommended by Johnston as a 
solvent of cerumen : 15 drops (1 Cc.) of a solution of 20 grains to 
I ounce (1.2 Gm. to 30 Cc.) of distilled water are dropped into the 
outer meatus, and the parts syringed an hour afterward with a 
solution of boric acid. 

Internally \ papain may be used for the same purposes as pepsin 
and pancreatin ; yet, while hypothetically superior, it is practically 
inferior to them, fortunately not having supplanted them in actual 
practice. 

Administration. — When used to aid digestion, papain should 
be given after meals, either in powders, capsules, compressed tablets, 
or aqueous solution, freshly prepared. 

Amylolytic Enzymes. 

In the germination of many seeds the starches contained therein 
are converted by enzymes into soluble starch or sugars, and thus 
nourish the young plant. Many bacteria are capable of breaking 
down starches, as well as proteids, and some moulds develop amy- 
lolytic, as well as proteolytic, enzymes of marked activity. 

Of late years much use has been made of a number of these 
enzymes. That from grain — barley, malt — containing the enzyme 
diastase has been widely used, especially in proprietary medicines. 

Maltum— Malti— Malt. U. 8. JP. 

Definition. — The grain of barley, Hordeum distichon L., partially germinated 
artificially and then dried. 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 501 

Extractum Malti— Extracti Malti— Extract of 
Malt. V. S. JP. 

This and Maltum are reintroductions into the Pharmacopoeia of articles admitted 
to the 1880 revision but dismissed in 1890; it is contained in the National Formulary. 

Description and Properties. — Malt extract consists of easily assimilable 
carbohydrates — maltose and dextrin — and small quantities of proteids ; the ash con- 
tains the phosphates of calcium and magnesium. If the malt has not been overheated 
(by which the diastase would be destroyed), and if the extract is prepared according to 
the U. S. Pharmacopoeia process, the preparation, when fresh, will contain diastase, 
which is an efficient ferment for the conversion of starch into dextrose ; the diastatic, 
power, however, rapidly deteriorates on keeping. 

Dose. — Average dose : 4 fluidrams (16 Cc), U. S. P. 

Diastase prepared from malt that has not been heated above 
1 35° F. is capable, in neutral or very slightly acid or alkaline solu- 
tions, of digesting appreciable quantities of starch. It is doubtful, 
however, if this action will take place in the stomach to any appre- 
ciable extent, and still more doubtful if, in the treatment of what 
has been termed starchy indigestion — amylaceous dyspepsia — such 
malt compounds are of any service. The clinical evidence adduced 
to the efficiency of such compounds should be taken with caution. 

One amylolytic ferment from a mould, the Aspergillus oryza 
(Ahlburg), which has been utilized in the breweries of Japan for 
centuries, particularly in the production of the Japanese rice wine 
(Sake), has been introduced within recent years into pharmaco- 
therapeutics under the name of taka-diastase. It is very active, but 
it is quite doubtful if it has any particular action on the undigested 
starch found in the intestines after it has been in the stomach for 
any length of time. Excellent clinical observers report good 
results, and it is deserving of trial. In all questions concerning 
the action of foreign ferments it should be remembered that they 
are largely foreign proteid bodies and are probably broken up and 
digested as such, apart from their action as enzymes, by the natural 
enzymes of the digestive tract, notably by pepsin. 

FATS AND OILS. 

Oleum Morrhuae— Olei Morrhuae— Cod-liver Oil. 

77. s. r. 

Origin. — A fixed oil obtained from the fresh livers of Gadus morrrhua L. and 
other species of Gadus. 

Description and Properties. — A pale-yellow, thin, oily liquid, having a 
peculiar, slightly fishy, but not rancid odor, and a bland, slightly fishy taste. Specific 
gravity 0.918 to 0:922 at 25 C. (77 F.). Scarcely soluble in alcohol, but readily sol- 
uble in ether, chloroform, or carbon disulphide, also in 2.5 parts of acetic ether. It 
contains glycerides of stearin and palmitin, traces of iodine, bromine, chlorine, biliary 
salts, phosphoric and sulphuric acids, and several alkaloids (leucomains), possibly de- 
composition-products. The most important of these, isolated by Gautier, are butyla- 
mine, hexylamme, amylamine, asseline, and morrhuine. It is doubtful if any one 
active principle exists in this oil. 

Morrhuol, a name given by Chapoteaut to a mixture of the various alkaloids and 
important principles of cod-liver oil, occurs as an amber-brown, bitter, aromatic liquid. 

Dose.— 1-4 fluidrams (3.8-15.0 Cc. ) [4 fluidrams (16 Cc), U. S. P.]. 



502 A TEXT-BOOK OF MA TERIA MEDICA. 

Emulsum Olei Morrhuae— Emulsi Olei Morrhuae— 
Emulsion of Cod-liver Oil. U. S. I>. 

A standard official preparation, containing 50 per cent, of cod-liver oil. It may be 
flavored to suit the taste, with oil of gaultheria, oil of bitter almond, etc. 
Dose. — Average dose: 2 nuidrams (8 Cc), U. S. P. 

Emulsum Olei Morrhuae cum Hypophosphitibus— 
Emulsi Olei Morrhuae cum Hypophosphiti- 
bus— Emulsion of Cod-liver Oil with Hypo- 
phosphites. U. 8. JP. 

Similar to oleum morrhuae, but containing the hypophosphites of calcium, potassium, 
and sodium. 

Dose. — Average dose : 2 fluidrams (8 Cc), U. S. P. 

Physiological Action. — Externally a7id Locally. — It possesses 
emollient properties, and may be applied to the skin and mucous 
membranes without causing irritation. It slightly reduces tempera- 
ture in fever when applied to the body. 

Internally. — Fat is a normal and necessary constituent of the 
body. It is the fuel used to supply energy, and those tissues and 
organs which are the most active require the most fat. Conse- 
quently, nerves, muscles, and glands are more abundantly fur- 
nished with fat than cartilage, and in cases of starvation those 
structures demanding the greater supply must have it, at the ex- 
pense of the less highly organized and active tissues — as is seen in 
the great emaciation preceding the decline of mental powers. The 
blood contains about one-half of I per cent, of fat ; the muscles, 3 
per cent. ; the brain, 8 per cent. ; and the nerves 22 per cent. In 
order, therefore, that the various cells of the body may possess 
sufficient vitality to withstand by physiological resistance the en- 
croachments of disease and the invasion of pathogenic micro- 
organisms, this equilibrium must be maintained. Yet this necessary 
food, fat, is more frequently deficient than any other, from the 
difficulty either of obtaining a supply or of digesting and assimi- 
lating it. 

Before oils or fats can enter the various cells and act as food, 
and consequently be a source of power, they must be digested and 
assimilated by the body. The value of an oil is based upon: (1) 
Its rate of absorption ; (2) its rate of oxidation ; (3) its agreeable 
taste. 

Cod-liver oil, while to many persons repugnant in taste, is more 
readily absorbed and oxidized than any other fat. It has already 
been prepared by the liver, and therefore partly elaborated, and, 
owing to the biliary salts which it contains, it passes more readily 
through animal membranes. Moreover, Naumann has shown that 
cod-liver oil is more easily oxidized than any other oil, rendering 
this substance almost an ideal ready-made food. Its actions upon 
the several systems are here considered. 

Digestive System. — Large doses disturb the stomach and may 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 503 

even occasion vomiting, but in medicinal doses alone, or in the 
form of an emulsion, it may be taken usually without discomfort, 
in some cases even increasing the appetite. In the stomach cod- 
liver oil is unaffected, but in the intestines it meets the pancreatic 
juice, which resolves a portion of it into glycerin and fatty acids, 
the latter combining with the alkalies of the bile and the intes- 
tinal juice to form soaps, while the remaining, and larger, por- 
tion is emulsionized by the alkaline secretions of the intestines. 

Circulatory System. — The number of red corpuscles is increased, 
and the quality of the blood is greatly improved. 

Nervous System. — This shares, with the other tissues of the 
body, the general amelioration, the drug being a food and tonic to 
the brain and nerves. 

Respiratory System. — No special action is noticeable other than 
the natural improvement in the respiratory power incidental to 
better blood and an increased functional activity of the nerves and 
muscles. 

Absorption and Elimination. — Cod-liver oil can be absorbed only 
after it enters the intestines. The glycerin and fatty acids formed 
by the pancreatic and the intestinal juices, together with the soaps 
produced by the action of the bile, are readily absorbed by the 
mucous membrane. 

The oil remaining, as has been stated, is emulsionized — that is, 
it is subdivided into minute globules, each enclosed in an envelope 
composed of alkaline albuminate and soap, which has a great 
affinity for the mucous membrane and carries the oil through the 
columnar epithelium of the intestinal villi into the lymph-spaces. 
The osmosis inward of the oil-emulsion is rendered still easier by 
the action of the bile with which the mucous membrane is bathed. 

It will be seen that much of the oil taken into the system is 
oxidized, being subsequently excreted as carbonic acid and water. 

Temperature. — When taken internally the temperature is unaf- 
fected, but, as has been observed, when applied to the epidermis 
the bodily heat is reduced. 

Untoward Action. — In addition to disturbances of digestion 
sometimes occasioned by moderate doses, cod-liver oil at times 
produces a vesicular eczema which may spread over the entire 
body. This eruption is probably caused by the volatile fatty acids 
which the oil contains. At times it may cause a diarrhea. 

Poisoning. — Cod-liver oil possesses no poisonous action. 

Therapeutics. — Exter?tally and Locally. — Cod-liver oil is much 
used by dermatologists in diseases of the skin, being especially ser- 
viceable in softening the crusts of eczema. It has been applied to 
the skin to allay irritatioyi and for the reduction of temperature in 
the exanthemata. 

Daily inunctions are beneficial in chronic scaly skin diseases, 
while a local application to the chest has seemed at times to influ- 
ence favorably the course of pertussis. 

Internally. — For two or three centuries cod-liver oil has been 



504 A TEXT-BOOK OF MA TERIA MEDICA. 

used both externally and internally for chronic rheumatism, but it 
*is only since 1 841 that it has been employed in the treatment of 
tuberculosis. While to-day it does not receive the enthusiastic 
support which attended its introduction in the latter disease, it is 
nevertheless a standard and highly efficacious remedy in the various 
forms of the disorder. It is equally valuable in scrofulous affections, 
and even more potent in rachitis. Chronic bronchitis is perhaps 
more frequently relieved by its use than by any other internal 
remedy. Diseases resulting in aiiemia are usually more benefited 
by cod-liver oil than by other remedial agents. Chronic arthritis, 
fistula and abscess in the neighborhood of the joints, have been 
greatly improved by its use. Atheroma of the arteries and many 
cutaneous diseases, particularly the strumous variety, and syphilo- 
dermata yield to its alterative and nutrient properties. 

Probably no single drug is employed in nervous diseases with 
effects so markedly beneficial as those of cod-liver oil. While 
possessing no specific action, it increases the strength and vitality 
of the patient, enabling him to resist morbid tendencies more suc- 
cessfully, and, by improving the condition of the nerves, lessens the 
liability to nervous derangement. 

Diabetes mellitus and Bright s disease, with anemia yet unat- 
tended by marked digestive disturbance, are decidedly improved 
by the administration of cod-liver oil. 

Should no gastric disorder supervene, this remedy should invari- 
ably be given in the last-named diseases. It certainly serves to 
maintain the general health, and is singularly efficacious in pro- 
longing the lives of the afflicted patients, enabling them to profit 
by hygienic measures, upon which great reliance should be placed. 
The tonic and nutritive properties of the drug have been strikingly 
shown in the rapid improvement of patients convalescing from 
acute diseases. In catarrhal conditions, especially in ozena and otitis 
following measles and scarlet fever, it is of marked benefit. 

Without entering upon specific considerations other than the 
above, it will be seen that cod-liver oil is indicated whenever there 
is defective activity, whether inherited or acquired. 

Contraindications. — It is to be remembered that cod-liver oil 
is a food and not a medicine : it is therefore contraindicated in all 
diseases where it proves detrimental to the appetite, causing eruc- 
tation, heartburn, diarrhea, etc. It is usually contraindicated in 
fevers, owing to the suspension of the secretions and impairment 
of digestion characteristic of acute febrile disorders. 

Administration. — In the early use of cod-liver oil it is advi- 
sable to prescribe small doses, that its toleration by the stomach 
may be gradually acquired. To many patients, however, it is ex- 
tremely distasteful, and the repugnance is increased rather than 
lessened by continued use. In such cases it is better, if possible, 
to disguise the taste and smell in some manner rather than to 
abandon so valuable a remedy when clearly indicated. Various 
means have been employed for this purpose. An emulsion may 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 505 

be made which obviates its disagreeable qualities. There are in 
the market soft capsules containing this oil that serve an excellent 
purpose, being easily swallowed and disguising completely the 
taste and odor of the drug. Administration should occur ordi- 
narily some time after meals, that the oil may reach the intestines 
as soon as possible. 

EMETICS, 

Emetics are agents which produce vomiting or emesis. 

Emesis is, in short, an antiperistaltic action, complex in its mech- 
anism. Emetics are largely out of fashion in medicine at the pres- 
ent time, but are in so much demand when needed, particularly in 
poisoning, that their consideration is worthy of separate treatment. 

The local or gastric emetics l are : 

* Alum ; * Yellow mercuric sulphate ; 

* Copper sulphate ; * Sodium chloride ; 

* Zinc sulphate ; * Ammonium carbonate ; 

* Mustard. 

Apomorphine hydrochloride, antimony and potassium tartrate, 
ipecacuanha, and lobelia are thought to be medullary emetics. 

Local or gastric emetics are the more rapid in their action, pro- 
ducing emesis in from two to five minutes. The systemic emetics 
must be absorbed and pass to the medulla before they produce 
vomiting, consequently requiring more time to exert their influence. 
Moreover, the action of the latter class of emetics is of much 
longer duration and followed by greater depression of the muscu- 
lar and circulatory systems, together w r ith greater constitutional 
disturbance. 

Some emetics act both locally and centrally. Tartar emetic and 
ipecacuanha affect the stomach locally, and it has recently been 
called in question whether their medullary action is even present, 
not to say important. Zinc sulphate and copper sulphate, while to 
a slight extent acting on the medulla, are classed as local emetics, 
because their principal action is upon the mucous membrane of the 
stomach. 

Within a few minutes after an emetic has been ingested there is 
a feeling of nausea and distress, with decided muscular relaxation. 
The circulatory system is depressed ; the pulse is small and irregu- 
lar, and a sensation of faintness ensues. The flow of saliva is 
increased, and vomiting soon follows. During emesis the arterial 
tension is raised, the face is flushed, and there is an increase in 
bodily heat. When vomiting has subsided there is a reduction of 
temperature, with cardiac and muscular weakness, the skin being 
bathed in perspiration. Occasionally fatal syncope has followed 
the use of emetics. 

1 (The drugs marked with an asterisk (*) are considered elsewhere in the present 
work. ) 



506 A TEXT-BOOK OF MATERIA MEDICA. 

Antagonists. — Drugs known as Antiemetics are used to allay 
nausea and check vomiting. Like emetics, these agents are divided 
into Local Antiemetics or Gastric Sedatives and Direct or Sys- 
temic Antiemetics, according to their action. 

Among the most important Antiemetics are the following : 

Local Antiemetics or Gastric Sedatives. 

(All of these are discussed elsewhere in the present work.) 

Alcohol (especially champagne) ; Ether ; 

Arsenic (small doses) ; Ipecac (small doses) ; 

Belladonna ; Ice ; 

Bismuth subnitrate and subcar- Opium ; 

bonate ; Hydrocyanic acid ; 

Carbolic acid ; Menthol ; 

Cerium oxalate ; Potassium nitrate ; 

Chloroform ; Silver nitrate ; 

Cocaine ; Sulphocarbolates ; 

Creasote; Tincture of iodine (small doses). 
Calomel (small doses); 

Direct or Systemic Antiemetics or Gastric Sedatives. 

Alcohol ; Chloral ; 

Ammonium ; Hydrocyanic acid ; 

Amyl nitrite ■ Nitroglycerin ; 

Bromides ; Opium. 

It will be observed that some drugs are both local and direct 
antiemetics. 

There are certain measures which may be adopted to allay 
nausea and relieve vomiting, such as a recumbent posture and 
injection of large quantities of aerated water into the rectum. 

Synergists. — The emetics are, of course, mutually synergistic. 
Emetics are adjuncts to antiperiodics and expectorants, although 
the latter do not particularly enhance the action of the former. 

Emetic are used : 

1. To empty the stomach in cases where the presence of undi- 
gested food occasions pain, headache, etc., or to expel some poison- 
ous substance from the stomach. For this purpose the local emetics 
are preferable. 

In cases of poisoning the local emetics are the more reliable. 

2. To remove foreign bodies from the esophagus. For this pur- 
pose the direct or systemic emetics should be used. 

3. To remove foreign bodies from the larynx, as in cases of mem- 
branous croup, laryngeal diphtheria, etc., the effort of vomiting 
being sometimes sufficient to dislodge and remove the membrane 
or other foreign substance. 

4. To remove the bronchial secretion in cases of bronchitis and 
catarrhal pneumonia. In these cases the direct emetics should be 



DRUGS ACTING ON GAS TRO-INTES TINA L ORGANS. S°7 

employed, preferably ipecacuanha or apomorphine, because they 
possess more expectorant properties. 

5. To empty the gall-bladder in cases of biliousness or malaria, 
or where small gall-stones are present in the gall-duct, the com- 
pression of the liver between the diaphragm and the abdominal 
muscles expelling the bile from the liver into the duodenum and 
forcing the gall-stones through the duct. 

6. To relax spasm of the pharyngeal muscles in cases of spas- 
modic laryngitis. For this purpose the systemic emetics are pref- 
erable. 

Contraindications. — Emetics should not be given to persons 
suffering from aneurism, hernia, peritonitis, prolapse of the uterus 
or rectum, atheroma, or where there is very high arterial tension, a 
tendency to hemorrhage from the lungs or uterus, or a tendency to 
abortion. 

The emetic drugs which have not been elsewhere discussed in 
the present work are here given in detail. 

Apomorphinae Hydrochloridum — Apomorphinae 
Hydrochloridi— Apomorphine Hydrochloride. 
U. S. jP. 

Origin. — The hydrochloride of an alkaloid prepared from morphine by the 
abstraction of one molecule of water. 

Description and Properties. — Minute, grayish-white, shining, acicular crys- 
tals, without odor, having a faintly bitter taste, and acquiring a greenish tint upon 
exposure to light and air. Soluble in about 39.5 parts of water and about 38.2 parts 
of alcohol. It should be kept in small, dark amber-colored vials. If the preparation 
imparts to 200 parts of water when slightly shaken an emerald-green color, the drug 
should be rejected. 

Dose. — 2 X o~to g ram (0.003-0.006 Gm.) by the mouth ; ^V - ! grain (0.0025-0.01 
Gm.) hypodermically [-Jg- grain as expectorant (0.002 Gm.) ; y 1 ^ grain as an emetic 
(0.005 Gm.), U. S. P.]. 

Physiological Action. — Externally and Locally. — None, 

Internally. — Digestive System. — From five to twenty minutes 
after ingestion — according to the dose and the manner of adminis- 
tration — vomiting ensues, being repeated three or four times at 
intervals of about fifteen minutes. The emesis is preceded and 
attended by a slight nausea, with but moderate depression. Apo- 
morphine is a typical direct or systemic emetic, its entire action 
being exerted upon the medulla. It is perhaps the most powerful 
and certain emetic we possess. So far as its systemic action is con- 
cerned, its relation to morphine should be remembered. 

Nervous System. — Full doses stimulate the brain and may even 
occasion delirium. Apomorphine frequently causes unconscious- 
ness and may be used as a hypnotic, like morphine. Convulsions 
have been observed when given in large doses. 

Circulatory System. — Small doses have no perceptible effect upon 
the circulation. Full doses increase the rapidity and force of the 
heart's action and raise arterial pressure, owing to stimulation of the 



508 A TEXT-BOOK OF MATERIA MEDICA. 

accelerator nerves and vasomotor center. Large or toxic amounts 
depress the circulatory system or paralyze the cardiac muscle. 

Respiratory System. — Small amounts do not affect the respira- 
tory movements, although the secretion from the bronchial mucous 
membrane is increased. Full doses accelerate and deepen respira- 
tion, while toxic amounts cause depression, as does morphine. 

Absorption mid Elimination. — Apomorphine is readily absorbed, 
and is excreted through the gastro-intestinal tract, as well as by the 
bronchopulmonary mucous membrane, the kidneys, and the skin. 

Temperature is unaffected by small doses, but may be lowered 
by large amounts. 

Poisoning. — The symptoms would be violent vomiting, delirium, 
or convulsions, and marked cardiac and respiratory depression, 
death resulting from asphyxia. 

Treatment of Poisoning. — As that of morphine-poisoning. 

Therapeutics. — Apomorphine is the most reliable emetic to use 
when prompt emesis is necessary or in cases where swallowing is 
difficult or impossible. 

It is extremely useful as an emetic in cases of poisoning, though 
it frequently happens in narcotic poisoning that the vagus center is 
so blunted by the poison that apomorphine fails to act. Should it 
be necessary to provoke emesis when the stomach is in a state of 
acute inflammation, apomorphine is preferable to any other emetic. 

Given by the mouth in small doses— from fa grain (o.ooi Gm.) 
to fa grain (0.003 Gm.) every three or four hours — this drug is an 
exceedingly efficient remedy in acute bronchitis. It is equally bene- 
ficial in relieving the dry, hacking cough of chronic bronchitis, chronic 
catarrhal pneumonia, and tuberculosis. 

Apomorphine in small doses has often proved a serviceable 
hypnotic. 

Contraindications. — The same as for emetics generally. It is 
contraindicated in morphine-poisoning. 

Administration. — Apomorphine when given as an emetic should 
invariably be administered hypodermically, and the solution be 
always freshly prepared. When the drug is used as an expectorant 
it should be given by the mouth. Great care should be taken in 
administering the drug to children, as they bear it badly. 

Antimonii et Potassii Tartras— Antimonii et Potas- 
sii Tartratis— Antimony and Potassium Tar- 
trate. U. S. P. 

(Tartar Emetic; Tartrated Antimony.) 

Origin. — Antimony trioxide is mixed with acid potassium tartrate and water to 
the consistence of a paste, allowed to stand for twenty-four hours, boiled in water, and 
crystallized. 

Description and Properties. — Colorless, transparent crystals of the rhombic 
system, becoming opaque and white on exposure to air, or a white, granular powder, 
without odor and having a sweet, afterward disagreeable, metallic taste. Soluble in 
15.5 parts Of water and in 3 parts of boiling water, but insoluble in alcohol, which 
precipitates it from its aqueous solution in the form of a crystalline powder. 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 509 

Dose. — 1-2 grains (0.06-0. 12 Gm. ) as an emetic; ^-1 grain (0.03-0.06 Gm.) 
as a cardiac depressant ; ^q-\ grain (0.003-0.01 Gm. ) as a diaphoretic and expec- 
torant [y 1 ^ grain (0.005 Gm.) as expectorant; ^ grain (0.03 Gm. ) as an emetic, 
U. S. P.]. 

Official Preparations. 

Syrupus Scillse Compositus — Syrupi Scillae Compositi — Compound Syrup 
of Squills (Hive Syrup). — Formula: Fluidextract of squill, 80; nuidextract of 
senega, 80; antimony and potassium tartrate, 2 ; sugar, 750 ; purified talc, 20; water, 
to 1000. 

Dose. — 5-60 minims (0.3-4.0 Cc). 

Vinum Antimonii — Vini Antimonii — Wine of Antimony. — Formula : Anti- 
mony and potassium tartrate, 4 ; boiling distilled water, 65 ; alcohol, 175 ; white wine, 

to IOOO. 

Dose. — 5-60 minims (0.3-4.0 Cc.) [15 minims (1 Cc), U. S. P.]. 

Antagonists and Incompatibles. — Opium, alcohol, and the 
cardiac stimulants and antispasmodics generally are antagonistic. 
Tannic and gallic acids and the lead salts are incompatible. 

Synergists. — Emetics, cathartics, and cardiac depressants pro- 
mote the action of tartar emetic. 

Physiological Action. — Externally and Locally. — Tartar emetic 
is a powerful irritant when applied to the skin, producing a follic- 
ular inflammation followed by a papular eruption, becoming vesic- 
ular, and later forming pustules with a central umbilication, desic- 
cation finally occurring, the pustules closely resembling those of 
small-pox. Necrosis and ulceration may follow prolonged applica- 
tion. 

Internally. — Digestive System. — Upon the mucous membrane of 
the gastro-intestinal tract, as upon the skin, antimony and potas- 
sium tartrate acts as a powerful irritant. Small doses, occasioning 
only a sensation of warmth in the stomach, soon produce an in- 
creased secretion of saliva and gastric juice, as well as of secretions 
from the intestines, liver, and pancreas, more or less nausea fre- 
quently accompanying these symptoms. 

A little larger dosage excites vomiting, due to the irritating action 
of the drug upon the mucous membrane and nerves of the stomach. 
After absorption, it is thought that, antimony has a direct action on 
the medulla, causing vomiting, but the evidence is not conclusive. 
Full or large doses irritate the intestines, producing diarrhea, the 
discharges, if the dose has been excessive, being very loose and 
watery. Severe cramps and epigastric pains accompany the fore- 
going symptoms. 

Nervous System. — Antimony and potassium tartate in small 
doses and under certain conditions exerts a sedative influence upon 
the brain. Indeed, its action is that of a depressant to the entire 
nervous system, particularly the spinal cord, small doses depressing 
the sensory side, while poisonous doses depress both the motor 
and sensory centers of the cord. The intense prostration is probably 
a result of the circulatory depression acting on the nerve-centers, 
rather than a direct nerve-cell involvement. 

Under the administration of antimony, therefore, reflex excita- 



510 A TEXT-BOOK OF MATERIA MEDICA. 

bility is diminished and the muscular system is depressed, the drug 
acting as an antispasmodic, probably by its influence both upon the 
muscles and the nervous system. 

Circulatory System. — Tartar emetic is a powerful cardiac de- 
pressant, even in small doses slowing and weakening the heart's 
action, and simultaneously lowering arterial pressure by direct 
depression of the heart muscle. 

Poisonous doses of the drug profoundly depress the heart, 
which is finally arrested in diastole. 

Respiratory System. — Very small doses have no effect upon the 
respiratory movements, but increase the secretions from the bron- 
chial mucous membrane. Full doses depress the respiratory move- 
ments, shortening the inspiration but prolonging expiration. Toxic 
doses render the breathing extremely irregular and greatly lengthen 
the pause between inspiration and expiration, while there is an 
enormous increase in the bronchial secretion. 

Absorption and Elimination. — Tartar emetic rapidly enters the 
blood, and is eliminated by many channels, principally by the 
bowels, but also by the bile, milk, sweat, and urine. The drug is 
an active diaphoretic, expectorant, and cholagogue. 

Temperature. — Small doses do not affect temperature percep- 
tibly ; large doses lower bodily heat, chiefly by depressing the 
circulation. 

Untoward Action. — The untoward manifestations produced by 
medicinal amounts of tartar emetic in individuals having a marked 
susceptibility to the drug do not differ essentially from the symp- 
toms of poisoning next described. 

Poisoning. — Tartar emetic produces all the symptoms of an 
irritant poison — severe burning sensation in the esophagus and 
stomach and violent and repeated vomiting, the ejecta, in addition 
to undigested food, containing mucus, bile, and frequently blood. 

These symptoms are attended with severe colicky pains in the 
abdomen and serous purging, the discharges resembling those of 
cholera, the analogy with the latter disease being rendered the 
more striking by the presence of cramps in the extremities — a char- 
acteristic feature of poisoning by tartar emetic. 

Together with these gastro-intestinal symptoms there is extreme 
prostration, accompanied by an irregular, weak, almost impercep- 
tible pulse, great muscular relaxation, depressed respiration, pinched 
and livid countenance, cold, clammy skin, reduction of temperature, 
and scanty and bloody urine. Death may be preceded by stupor, 
wild delirium, or convulsions. Fatal dose of tartar emetic has been 
2 grains (o. I Gm.) — although much larger quantities have been 
taken. The prompt emesis has served to prevent poisoning. 

Treatment of Poisoning. — If the poison has not been entirely 
ejected in the act of vomiting, the stomach should be immediately 
washed out with a solution of tannic acid, after which strong coffee 
should be administered, together with demulcent drinks, anodynes, 
and respiratory and cardiac stimulants should they be necessary. 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 511 

Therapeutics. — Externally and Locally. — Tartar emetic was 
formerly used as a rubefacient, being still so employed to some 
extent. The tendency of the drug, however, to produce extensive 
papular eruption and destruction of tissue renders its external use 
unsafe. Hebra considers that the external use of tartar emetic is 
a " useless, injurious procedure, and occasionally even dangerous 
to life." 

Internally. — The medical uses of tartar emetic are constantly 
becoming more restricted. Because of its slow and depressing 
action the employment of the drug as an emetic has been prac- 
tically abandoned. It is still used as a sedative in various acute 
inflammations. It is beneficial in the early stages of acute laryngitis 
and bronchitis, but its administration should be discontinued after a 
free secretion of bronchial mucus is established. 

The remedy is given by many practitioners in the early stages 
of acute lobar pneumonia. 

The compound syrup of squills is a useful expectorant, being 
a popular and efficient remedy for spasmodic affections, particularly 
spasmodic laryngitis-. 

Administration. — As an emetic the action of the drug is facili- 
tated and enhanced by associating it with ipecacuanha, the remedies 
together being given in powdered form. 

As a diaphoretic and expectorant small doses of the wine of 
antimony are preferable, repeated every two or three hours. 

Ipecacuanha— Ipecacuanhae— Ipecac. U. S. .P. 

Definition. — The dried root, to which may be attached a portion of the stem, 
not more than 7 Cm. in length, of Cephaelis Ipecacuanha (Brotero) A. Richard, 
known commercially as Rio, Brazilian, or Para Ipecac, or the corresponding portion 
of C. acuminata Karst, known commercially as Carthagena ipecac, yielding not less 
than 2 per cent, of ipecac alkaloids. 

Description and Properties. — The older roots of Rio ipecac are in pieces 
of 2 to 6 inches (5-15 Cm.) in length and about \ inch (4 Mm.) thick, mostly simple, 
contorted, dull grayish-brown or blackish, finely wrinkled, closely and irregularly 
annulated and often transversely fissured ; bark thick, brittle, brownish, easily sepa- 
rated from the thin, whitish, tough, ligneous portion; odor slight, peculiar, nauseous ; 
taste bitterish, acrid, nauseating. When ipecac is sound and free from mouldiness its 
quality is proportionate to the thickness of the bark and the thinness of the ligneous 
portion. 

Carthagena ipecac is similar to Rio and about one-half thicker. 

The active principles of ipecac are emetine and cephaeline, of the former of which 
there is present I to 2 per cent. The drug also contains ipecacuanhic or cephaelic 
acid, starch, resin, etc. 

Dose. — As an emetic, 15-30 grains (1.0-2.0 Gm.) ; as an expectorant, \-2 grains 
(0.03-0.12 Gm.). 

Official Preparations. 

Fluidextractum Ipecacuanhae — Fluidextracti Ipecacuanhas — Fluidextract 
of Ipecacuanha. 

Dose. — As an emetic, 15-30 minims (0.2-0.5 Cc. ); as an expectorant, y z -2 
minims (0.03-0.12 Cc.) as an emetic, [15 minims (1 Cc.) ; as an expectorant, I minim 
(0.05 Cc), U. S. P.]. 

Pulvis Ipecacuanhas et Opii— Pulveris Ipecacuanhae et Opii — Powder of 
Ipecac and Opium. (See Opium.') 

Syrupus Ipecacuanhae — Syrupi Ipecacuanhae— Syrup of Ipecac. — Formula : 



512 A TEXT-BOOK OF MATERIA MEDIC A. 

Fluidextract of ipecac, 70; acetic acid, 10; glycerin, 100 ; sugar, 700 ; water, to 
1000. 

Dose. — As an emetic, 2.6 fiuidrams (7.39-22.50 Cc.) ; as an expectorant, 5-30 
minims (0.3-2.0 Cc.) [as an expectorant, 15 minims (1 Cc.) ; as an emetic, 4 fluid- 
drams (15 Cc), U. S. P.]. 

Tinctura Ipecacuanhae et Opii — Tincturae Ipecacuanhas et Opii — Tincture 
of Ipecac and Opium. (See Opiian.) 

Vinum Ipecacuanhae — Vini Ipecacuanhae — Wine of Ipecac (10 percent.) — 
Dose, 1-60 minims (0.06-4.0 Cc.) [15 minims (1 Cc), U. S. P.]. 

Antagonists and Incompatibles. — The gastric sedatives and 
narcotics generally hinder the emetic properties of ipecac. The 
incompatibles are tannic acid and vegetable infusions containing 
it, metallic salts, and caustic alkalies. 

Synergists. — The emetics, sedative expectorants, warm drinks, 
are synergistic, and opium aids the diaphoretic properties of the 
drug. 

Physiological Action. — Externally and Locally. — Ipecac is a 
powerful irritant to the mucous membranes of the respiratory tract 
when the powdered drug is inhaled. The prolonged application 
of ipecac to the skin occasions much irritation, even producing 
vesication, pustulation, and ulceration. Ipecac also possesses some 
antiseptic properties. 

Internally. — Digestive System. — In small doses ipecac acts as a 
stimulant to the stomach. The salivary and gastric glands are 
stimulated, the action of very small doses of the drug resembling 
that of vegetable bitters. 

Large doses are powerfully irritant and emetic, the emesis being 
the result of both a local irritation upon the stomach and perhaps 
some slight action on the vomiting center. The vomiting is pre- 
ceded by and attended with but little, if any, nausea, although there 
is usually a marked increase in the secretion of bile and intestinal 
mucus, full doses of the drug acting not only as an emetic, but as a 
purgative and cholagogue. 

Nervous System. — Save in slight stimulation of the medulla 
oblongata and a slight diminution of the reflex activity of the spinal 
cord, ipecac has no important action upon the nervous system. 

Circulatory System. — Except in occasioning the ordinary depres- 
sion incident to the act of vomiting, ipecac in moderate amounts 
has no influence upon the heart. Enormous doses, however, par- 
ticularly if injected into the jugular vein, have destroyed the life 
of dogs by cardiac paralysis. 

Respiratory System. — So far as the respiratory movements are 
concerned, they are unaffected by moderates doses of ipecac. The 
bronchial mucus membrane is stimulated, augmenting the secretion 
of bronchial mucus, and therefore reflexly stimulating coughing. 

Absorption and Elimination. — The active principles of ipecac are 
rapidly absorbed, being eliminated chiefly by the gastro-intestinal 
mucuous membrane, although the other secretions share in the 
excretory process, the skin being especially affected by this drug, 
which acts as a mild diaphoretic. 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 513 

Temperature. — Under medicinal doses the temperature is un- 
changed. Poisonous doses reduce temperature. 

Untoward Action. — Rarely, in persons peculiarly susceptible to 
the drug, intense cutaneous irritation and conjunctival inflammation, 
accompanied by neuralgia of the face and scalp, have been produced. 
Even soiling the hand with a few drops of the tincture of ipecac has 
occasioned unfavorable results. 

Poisoning. — There is violent vomiting and purging, the ejecta 
containing bile and frequently blood. Among the graver symp- 
toms are abdominal pain, marked cardiac depression, muscular 
weakness, and greatly diminished reflex irritability. The skin is 
cold and bathed in perspiration. 

Treatment of Poisoning. — Tannic acid should be given as the 
chemical antidote. Opium, belladonna, and cardiac stimulants may 
be necessary. 

Therapeutics. — Externally and Locally. — Troches of ipecac 
and spray inhalations of wine of ipecac are used to allay the cough 
and expectoration in acute bronchitis and obstinate " winter cough? 

I?iternally. — Ipecac in proper doses is a very efficient emetic, 
and is frequently employed as such, particularly when it is desir- 
able through the act of vomiting to empty the air passages, as in 
spasmodic laryngitis, bronchitis, tracheitis, and the early stages of 
diphtheria. The action of the drug is so tardy, however, that it is 
not the most desirable emetic to use when it is necessary to empty 
the stomach quickly, as in cases of poisoning. 

When the stomach contains a quantity of undigested food, 
causing pain, headache, etc., ipecac is a valuable emetic, since the 
drug occasions little marked nausea or depression. 

Minute doses of ipecac, such as 1 to 4 minims (0.06-0.2 Cc.) 
of the wine or -^ to i grain (0.006-0.01 Gm.) of the powdered 
drug, act as an efficient gastric sedative and stomachic, frequently 
arresting vomiting when other drugs have failed. The statement, 
however, that minim doses of the wine of ipecac allay the nausea 
and vomiting of pregnancy is probably apocryphal. 

Ipecac in small doses is an excellent adjuvant to other chola- 
gogues to relieve the distress of hepatic dyspepsia. The drug is 
equally advantageous in atonic dyspepsia, attended with flatulence, 
depression of spirits, etc. 

The notoriety and pecuniary profit which Helvetius secured in 
connection with ipecac — or Radix a?itidysenterica, as it was origi- 
nally named by its propagator — were due to its apparent specific 
action in dysentery. 

The drug is peculiarly efficient in dysentery. Whatever the 
form of dysenteric attack may be, ipecac is the more efficient the 
earlier it is administered. 

The drug, in order to exert any beneficial influence in bilious 
dysentery, must be given in large doses — 60 to 90 grains (3.88- 
5.83 Gm.) in a single dose, or 20 grains (1.29 Gm.) every four hours. 
These doses, of course, will at first produce emesis, but the repeti- 



514 A TEXT-BOOK OF MATERIA MEDICA. 

tion of them tends to establish a tolerance of the remedy, an early- 
attainment of which is most desirable. 

Various methods have been employed to aid the stomach in 
retaining the drug, such as the administration of opium or other 
gastric sedative, a sinapism placed upon the epigastrium, etc. 

Ipecac has been highly recommended in infantile diarrhea. It 
has been successfully employed in hematemesis and uterine hemor- 
rhage, it being customary in the former complaint to give at first 
an emetic dose, succeeded by smaller and nauseating amounts. 

Like other emetics, ipecac has proved efficient in expediting 
labor by relieving rigidity of the os uteri. 

The drug has been found beneficial in relieving Jiemoptysis, and 
it is of unquestioned value in many affections of the lungs and 
bronchial tubes. In pneumonia, particularly in the congestive and 
declining stages of the disease, it has proved serviceable. 

In bronchitis and phthisis, especially when the secretion is scanty, 
and in chronic bronchitis with much cough and but a moderate 
amount of expectoration, ipecac is a valuable remedy. It has been 
found valuable in spasmodic asthma. 

Ipecac is an important adjuvant to quinine in the treatment of 
remittent and intermittent fevers, the latter disease having been 
cured, it is claimed, by ipecac alone in doses of I or 2 grains 
(0.06-0.12 Gm.), given every three or four hours. 

Contraindications. — Ipecac is not permissible for patients suf- 
fering from aneurism, hernia, prolapse of uterus or rectum, etc. 

Administration. — The drug is notoriously uncertain in its 
action, probably because of the variation in the percentage of eme- 
tine, the freshly powdered root being ordinarily more reliable. 

As a diaphoretic the powder is also preferable, though in any 
case the fluidextract may be substituted for the powdered form. 
As an expectorant the syrup and wine are the preparations usually 
employed. 

Children are very tolerant of ipecac, the syrup being the prepa- 
ration usually given to them. 

Emetine, represents the crude drug fully, and may be admin- 
istered as an emetic in doses of T ^ to \ grain (0.005-0.01 Gm.), and 
in correspondingly small doses when a diaphoretic or expectorant 
action is desired. It has been found extremely difficult to prepare 
it free from other substances. 

Lobelia— Lobeliae— Lobelia. U. S. JP. 

(Indian Tobacco ) 

Origin. — The dried leaves and tops of Lobelia inflata L., collected after a portion 
of the capsules have become inflated. The plant is indigenous in the United States. 

Description and Properties. — As it appears in the market lobelia consists 
of fragments of green leaves, stems, rather elongated dried flowers, and portions of the 
membranous capsules. The odor is very irritating, and the taste pungent and persist- 
ently acrid. The plant contains a yellowish acrid liquid alkaloid, lobeline, besides 
lobclic arid, lobelacrin, resin, fixed oil. gum. etc. 

Dose. — J-io grains (0065-0.6 Gm ) \j\ grains (5 Gm.), U. S P.]. 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 515 

Official Preparations. 

Fluidextractum Lobeliae — Fluidextracti Lobelise — Fluidextract of Lobelia. 
— Dose, i-io minims (0.06-0.6 Cc. ) [8 minims (0.5 Cc), U. S. P.]. 

Tinctura Lobeliae— Tincturae Lobeliae— Tincture of Lobelia (10 per cent.). 
— Dose, 8-15 minims (0.5-1.0 Cc.) [15 minims (i Cc.) as expectorant; I fluidram 
(4Cc.) as emetic. U. S. P.]. 

Antagonists and Incompatibles. — The effects of lobelia on the 
circulatory system are antagonized by the cardiac stimulants. The 
incompatibles are all caustic alkalies. 

Synergists. — The motor depressants and emetics enhance the 
effect of lobelia. 

Physiological Action. — Externally and Locally. — Although the 
drug is readily absorbed through the skin, there is no action of 
importance. 

Internally. — Digestive System. — Lobelia produces symptoms 
similar to those of ipecac, save that lobelia is more powerful, occa- 
sioning more distressing nausea and intense prostration. 

Nervous System. — Full doses depress the motor nerve-ganglia. 
Poisonous doses are necessary to affect the higher cerebral centers, 
when coma and convulsions are produced. The muscles and 
nerves themselves are unaffected by lobelia. 

Circulatory System. — Lobelia is a powerful cardiac depressant, 
its action being due both to direct depression of the heart and 
paralysis of the vasomotor centers. Under poisonous doses the 
heart stops in diastole. 

Respiratory System. — The muscular coats of the bronchi are 
relaxed by the drug. The respiration is slowed even by small 
doses. Large or toxic doses profoundly depress the respiratory 
center, death resulting from respiratory failure. 

Absorption and Elimination. — The active principle of lobelia is 
readily absorbed, and is excreted chiefly by the kidneys and 
skin, the drug acting as a diuretic and diaphoretic. Under emetic 
doses much of the drug is eliminated by way of the stomach and 
intestines. 

Temperature. — Full doses lower the temperature. 

Untoward Action. — Does not differ essentially from the effects 
of poisoning. 

Poisoning. — The symptoms include — violent vomiting and 
purging, a very weak and irregular pulse, an anxious, livid coun- 
tenance, skin cold and bathed in perspiration, respiration slow and 
very feeble, contracted pupils, and possibly coma or convulsions 
preceding death, which occurs from respiratory failure. 

Treatme?it of Poisoning. — The symptoms should be counter- 
acted by cardiac and respiratory stimulants, employing such drugs 
as atropine, strychnine, alcohol, ammonia, etc., hypodermically. 

Therapeutics. — Externally and Locally. — None. 

Internally. — While formerly lobelia was used extensively as an 
emetic, at the present day, owing to the intense nausea and great 



516 A TEXT-BOOK OF MATERIA MEDICA. 

depression occasioned by the drug, it has been practically sup- 
planted by other less dangerous emetics. 

Its principal use nowadays is as a remedy in spasmodic asthma 
and as an expectorant in certain cases of bronchitis. 

Contraindications. — The same as for emetics in general. 

Administration. — The powder, fluidextract, or tincture may 
be used. 

CATHARTICS* 

Cathartics or Purgatives are substances which cause evacua- 
tion of the bowels either by direct local irritation of the intestinal 
mucous membrane or by setting up an osmotic current from the 
tissues toward the lumen of the intestines, causing an accumulation 
of fluid in the bowels — in both cases causing increased peristalsis 
and watery or semisolid evacuations. 

Mechanism of Purgation. — It should be remembered that the 
epithelial surfaces through which the substances needful to the 
body enter it, and the waste-products leave it, are physiologically 
outside the body. The mucous membrane of the alimentary canal 
is in a sense as much external as the skin covering the surface of 
the body and is subject to the same irritating influences. The 
muscular mechanism of the intestines is somewhat peculiar in that 
it possesses the power to rhythmically contract and relax in a 
w r ave-like manner (peristalsis), the peristaltic wave traveling down- 
ward. These rhythmical movements of the intestines carry their 
contents along their lumen from the cardia to the rectum, and are 
to a large extent independent of the central nervous system, 
although controlled by nervous mechanisms. The normal con- 
tents of the small intestine are fluid, and are passed into the large 
intestine as such. In their passage along the large bowel the fluid 
part is largely absorbed and the semisolid part remaining is passed 
on into the rectum as feces. 

In order that any substance may act as a purgative it must 
change the normal contents of the bowels in such a way as to 
cause fluid or semisolid evacuations. When a substance locally 
irritates the intestinal mucous membrane the intestines respond by 
increased peristalsis, which hurries the fluid contents of the small 
intestine through the large bowel so rapidly that absorption does 
not take place and the feces are evacuated in a fluid form. 

Cathartics may be classified according to their various actions, 
the following- table serving to show how and where the various 
drugs exert their several influences : 

Intestinal peristalsis is increased probably by : 

Stimulation of: 

1. The intestinal muscles (moderate stimulation); 

2. The afferent nerves connecting the intestinal mucous mem- 

brane with Auerbach's ganglia; 

3. Auerbach's ganglia; 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 517 

4. The ends of the efferent nerves passing from Auerbach's 

ganglia to the intestinal muscles ; 

5. The ends of the afferent nerves passing from the intestinal 

mucous membrane to the brain ; 

6. The motor centers in the brain ; 

7. The ends of the motor nerves terminating in Auerbach's 

ganglia. 
Depression of: 

8. The inhibitory motor center ; 

9. The ends of the inhibitory motor nerves terminating in 

Auerbach's ganglia; 
10. The inhibitory motor center in the suprarenal plexus. 

It will be seen that any substance which stimulates the motor 
apparatus or depresses the inhibitory motor mechanism will increase 
peristalsis. 

Intestinal secretion may doubtless be promoted by any sub- 
stance which serves to stimulate the secretory or the vasodilator 
apparatus, or to depress the inhibitory secretory or vasoconstrictor 
mechanism. 

The methods by which absorption is diminished are not thor- 
oughly understood, but it is known that : 

1. By increasing peristalsis and hastening the removal of fluid 

from the bowels absorption takes place less rapidly ; 

2. By giving drugs — e.g., magnesium sulphate — having high 

osmotic equivalents, with a great affinity for water, the 
absorption of fluid is prevented ; 

3. Substances which in some manner affect the columnar 

epithelium of the intestinal glands retard absorption ; 

4. Drugs which diminish the circulation in the intestinal 

mucous membranes act as deterrents to the absorptive 
process. 

It is apparent that certain drugs produce various effects, and 
that their mode of action varies according to the size of the dose 
and occasionally with the idiosyncrasy of 'the patient. 

Nearly all cathartic drugs act by some local influence upon the 
intestinal mucous membranes previous to absorption ; others, again, 
affect the bowels after they have entered the circulation — strychnine, 
for example, physostigmine, pilocarpine, etc., acting in this manner. 

Certain other drugs, such as podophyllin, colocynth, etc., if in- 
jected into the circulation, are excreted by the mucous membrane 
of the intestines, and by their irritation produce catharsis. 

The condition of the intestinal canal has much to do with the 
activity of certain drugs. Thus, certain medicines produce cathar- 
sis regardless of the reaction of intestinal fluids ; others are inert 
without the presence of bile or other alkaline fluids or salts ; and 
still a third class occasion catharsis only when after ingestion they 
come in contact with an acid. Of the last-mentioned, magnesium 
carbonate is an excellent example, the drug being inert unless it be 
acted upon by an acid in the stomach or bowels. 



518 A TEXT-BOOK OF MATERIA MEDICA. 

It is an interesting fact that, as shown by experience, different 
cathartics may act more energetically upon different portions of the 
intestines. The action of calomel, for instance, is almost entirely 
confined to the duodenum, while aloes acts largely upon the de- 
scending colon and the rectum. 

In selecting a cathartic, therefore, a knowledge of the part of 
the intestinal canal to be acted upon and the locality in which the 
drug operates is necessary in order to secure the most satisfactory 
results. 

Many cathartics contain principles which render them tonic to 
the stomach ; some few are thought to directly stimulate the 
hepatic cells — mercury preparations ; while the cholagogues merely 
hasten the expulsion of the bile from the intestinal canal, prevent- 
ing its absorption. 

Certain drugs, being excreted in the milk, which it renders pur- 
gative, are well adapted for administration to the nursing mother in 
order to produce catharsis in the infant. Castor oil, greatly aug- 
menting the secretion of milk, is an excellent medium as a laxative 
in such cases. 

Aloes increases the menstrual flow ; other drugs promote the 
secretion of urine, etc. 

Therapeutics. — Cathartics are employed : 

To remove feces and produce a simple evacuation of the bowels. 
The laxatives are best adapted for this purpose. 

For the relief of chronic constipation. For this purpose great 
judgment is requisite in the selection of a drug or combination of 
agents, it being important to determine whether there is diminished 
peristalsis or secretion ; whether there exists an atonic condition of 
the intestinal muscles ; or whether the disorder is located in the 
small intestine, the colon, or the rectum. 

To remove from the bowels noxious substances or pathogenic 
matter. For this purpose the mercurial preparations, calomel or 
gray powder, are best, since they are not only active cathartics, but 
bactericides as well. 

To deplete the gastroduodenal mucous membrane, where the 
congested and swollen mucous membrane obstructs the outflow of 
bile, resulting in jaundice. In this condition the salines, especially 
the sodium salts, are the most efficient cathartics. 

To promote absorption and remove dropsical effusions in certain 
diseases of the heart, liver, and kidneys. Here active catharsis is 
necessary, the hydragogue cathartics being indicated. 

To remove urea, etc., from the blood. Occasionally in certain 
renal diseases the functional activity of the kidneys is so defective 
that waste- matter, urea, etc., rapidly accumulates in the body, 
occasioning uremic convulsions, coma, or other serious symptoms. 
In such cases it may be necessary to give a drastic purgative, such 
as croton oil, which acts rapidly, causing profuse watery stools. 

To lower the blood-pressure where high arterial tension aggra- 
vates a malady, as at the onset of many acute diseases, and in cere- 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 519 

bral hemorrhage, meningitis, etc. In these conditions it is necessary 
to employ such drugs which, by dilating the intestinal blood-vessels, 
drain the blood away from other organs and cause abundant watery 
discharges from the bowels. Hydragogue or drastic purgatives 
answer the required purpose. 

For the relief of hemorrhoids, in which cases the mild laxatives, 
such as sulphur, senna, etc., are serviceable. 

To aid the restoration of the catamenia. For this purpose aloes 
is usually employed, particularly if it be necessary to determine 
more blood to the pelvic organs. If depletion be required, the 
selection should be made from the hydragogue cathartics. 

To purge the nursing infant through the mother's milk. For this 
purpose such drugs as rhubarb, senna, and castor oil may be admin- 
istered to the mother. 

To lower the temperature in fever, in which cases the saline 
cathartics may be advantageously employed. 

Contraindications. — Active catharsis by the more powerful 
hydragogue or drastic purgatives would be contraindicated in ap- 
pendicitis, peritonitis, typhlitis, intussusception, pregnancy, and 
typhoid fever, or where there is inflammation of the mucous mem- 
brane of the gastro-intestinal tract. 

Administration. — Probably no group of medicines demands 
greater judgment in the administration than cathartics. 

Ordinarily, the efficiency of these agents is increased and their 
operation rendered less irritant by associating drugs acting upon 
different portions of the alimentary canal. Their action, too, is 
more prompt and certain when the remedies are given upon an 
empty stomach and the efficiency of their operation is enhanced by 
exercise and diminished by sleep. 

The action of cathartics is promoted by the addition of small 
doses of emetics, mydriatics, quinine, and bitters, quinine especially 
strengthening the action of magnesium sulphate. Mild diluent 
beverages also promote the activity of cathartics. Cold applied 
to the abdomen, enemata, massage of the abdominal walls, and 
electricity, all act as adjuvant measures in the employment of 
purgative medicines. 

As has been previously suggested, a knowledge of the portion 
of the intestinal canal upon which the various cathartics act is of 
primary importance. Thus, if it be necessary 7 to influence only 
the duodenum, calomel or podophyllum should be used ; if the 
small intestine, senna or jalap ; if the descending colon or rectum, 
aloes — these drugs acting chiefly upon these organs. 

Moreover, due consideration should be given to the proper time 
for the administration of the different cathartics, the resinoid pur- 
gatives acting best when taken at night or before dinner, and the 
salines when taken in the morning before breakfast. 

The mode of administration is also of great importance, in 
order to obtain from these agents the fullest benefit. The salines, 
for instance, act best when given in solution in either very cold or 



520 A TEXT-BOOK OF MATERIA MEDIC A. 

very hot water, their activity being enhanced by association with 
bitters, iron, or sulphuric acid. On the other hand, the resinoid 
drugs should be administered in the form of pills, and if, for any 
reason, it is desirable that the drug should enter the intestine with- 
out coming in contact with the mucous membrane of the stomach, 
the drug may be given in the form of pills coated with keratin, 
which is unaffected by the gastric juice, but readily dissolved in 
the alkaline intestinal juices. 

In the following detailed description cathartic drugs are grouped 
according to their modus operandi, the mildest drugs or laxatives 
being first considered. 

LAXATIVES. 

Certain substances never produce active purgation, but simply 
unload the bowels by slightly increasing both peristalsis and secre- 
tion, expelling the feces in a softened, though solid and formed, 
condition, without irritation and without perceptibly affecting the 
general system. 

These agents are especially useful where we wish to evacuate 
the bowels with the least possible local derangement, as in simple 
constipation from dyspepsia, in children, pregnant women, con- 
valescents from acute disease, or patients affected with hemorrhoids, 
hernia, affections of the rectum or womb, typhoid fever, early 
simple diarrhea, or in inflammation or surgical operations about 
the abdomen and pelvis. 

In addition to the laxative drugs here mentioned there are 
many articles of diet which by purely mechanical action produce 
catharsis, such as oatmeal, brown bread, whole flour, molasses, 
prunes, figs, onions, spinach, celery, lettuce, etc. 

Cassia Fistula— Cassiae Fistulae— Cassia Fistula. 

V. S. JP. 

(Purging Cassia.) 

Origin. —The dried fruit of Cassia Fistula L., a tree 30 to 50 feet (9-15 M.) 
high, indigenous in the East Indies. 

Description and Properties. — Cylindrical, \]/ z to 2 feet (45-60 Cm.) long, 
nearly I inch (25 Mm.) in diameter, blackish brown, somewhat veined, the sutures 
smooth, forming two longitudinal bands ; indehiscent, internally divided transversely 
into numerous cells, each containing a reddish-brown, glossy, flattish-ovate seed 
imbedded in a blackish-brown sugary pulp ; odor resembling that of prunes. 

Dose. — 1-2 drams (4.0-8.0 Gm.) [1 dram (4 Gm. ), U. S. P.], 

Official Preparation. 

Confectio Sennae — Confectionis Sennae — Confection of Senna. — Described 
under Senna. 

Physiological Action and Therapeutics. — Cassia is a mild and 
pleasant laxative. It is seldom given alone, however, but forms an 
ingredient in the confection of senna. 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 521 

Oleum Ricini— Olei Ricini— Castor Oil. U. 8. JP. 

Origin. — A fixed oil compressed from the seed of Ricinus communis L., a plant 
indigenous in Southern Asia and cultivated in temperate countries for ornament and 
other purposes, remaining a large annual. 

Description and Properties. — A pale-yellowish or almost colorless, trans- 
parent, viscid liquid, having a faint, mild odor and a bland, afterward slightly acrid 
and generally offensive taste. Soluble in an equal volume of alcohol and all propor- 
tions in absolute alcohol. Castor oil should be kept in well-stoppered bcttles. 

Dose. — %-2 fluidounces (8.0-60.0 Cc.) [4 fluidrams (16 Cc), U. S. P ]. 

Physiological Action. — Externally and Locally.— Castor oil — 
like other bland fixed oils, such as almond oil, olive oil, etc. — is 
sedative and protective when applied to the skin or mucous mem- 
branes. 

Internally. — The only important action is upon the intestinal 
tract, on which the oil acts as a mild irritant, causing purgation. 
Chemically castor oil is a combination of glycerin, fatty acids, and 
ricinoleic acid. This combination goes through the stomach un- 
changed, but in the presence of the bile and pancreatic juice it is 
broken up into glycerin and ricinoleic acid ; the ricinoleic acid com- 
bines with sodium and forms sodium ricinoleate, which has marked 
irritating properties. The ricinoleate of sodium is absorbed and 
excreted in various ways, appearing in the mother's milk and 
imparting to it purgative properties. 

Castor oil requires from four to six hours to operate, its action 
being usually attended with little pain. It causes a large, soft stool 
and usually empties the entire intestinal canal. 

The poisonous principle, ricin, found in the seed-coat of castor oil 
beans, is an albuminous substance belonging to the globulin group, 
and is generally termed a toxglobulin. Ricin is one of the most 
powerful poisons known, but being insoluble in oil and soluble in 
water it is not present in expressed castor oil. The symptoms of 
poisoning from castor beans are violent abdominal pain, vomiting, 
purging, and collapse. Postmortem examinations have revealed 
evidences of severe inflammation in the stomach and intestines, with 
capillary thrombi in various organs. 

Castor oil should not be used as an habitual laxative, its con- 
tinual employment being liable to occasion constipation with all its 
attendant evils. 

Therapeutics. — Castor oil is used alone or associated with bal- 
sam of Peru as a sedative protectant dressing for superficial ulcera- 
tions. The drug is also serviceable in various diseases of the skin 
and mouth. 

It is probably superior to all other laxatives, and is applicable 
to all conditions for which laxatives are employed. In large doses 
it is one of the best purgatives to give in conjunction with an 
anthelmintic. 

Administration. — The unpleasant taste of castor oil is the only 
objection to its use. Yet it can be rendered quite palatable by 
mixing it with a small quantity of glycerin, to which may be added 
a few drops of oil of cinnamon or oil of wintergreen. 



522 A TEXT-BOOK OF MATERIA MEDICA. 

Various other devices for disguising the taste have been adopted, 
such as enveloping the oil in the froth of beer, ale, or porter, or 
washing out the mouth with brandy or whisky previous to admin- 
istration, and allowing the patient to swallow the oil quickly, when 
it will not adhere to the mouth and fauces, especially if followed by 
a drink of some alcoholic liquid. 

In the form of an emulsion the taste of the oil is well disguised. 
There are also soft capsules of castor oil which are, of course, taste- 
less, yet they are too bulky to be popular. 

Castor-oil emulsion may be used as an enema when a mild 
injection is required. 



Rhamnus Purshiana— Rhamni Purshianae— 
Cascara Sagrada. U. 8. JP. 

Origin. — The dried bark of Rhamnus Purshiana D. C, collected at least one 
year before being used. Rhamnus Purshiana is a shrub or small tree 15 to 20 feet 
(4.5-6 M.) high, indigenous on the Pacific coast of North America from the British 
possessions southward to Northern California. 

Description and Properties. — Quills or curved pieces about % to 4 inches 
(3-10 Cm. ) long and about -^ inch (2 Mm.) thick ; outer surface brownish gray and 
whitish, the young bark with numerous, rather broad, pale-colored warts ; inner surface 
yellowish to light-brownish, becoming dark-brown with age ; smooth or finely striate, 
fracture short, yellowish, in the inner layer of thick bark somewhat fibrous ; inodorous ; 
taste bitter. 

The bark contains red, yellow, and brown resins, containing anthraquinone deriv- 
atives — anthracenes — tannic, malic, and oxalic acids, a volatile oil, and possibly a glyco- 
side, xantho-rhamnin or purshianin. 

Dose. — 30-60 grains (2.0-4.0 Gm.) [15 grains (1 Gm.), U. S. P.]. 

Official Preparations. 

Fluidextractum Rhamni Purshianae Aromaticum — Fluidextracti Rhamni 
Purshianae Aromatici — Aromatic Fluidextract of Cascara Sagrada (U. S. P.). 
— This is the aromatic fluidextract of cascara sagrada of the National Formulary. It 
differs from the fluidextract, which was already official, in having an aromatic flavor 
and being devoid of the intensely bitter principle occurring in the bark. 

Dose. — Average dose: 15 minims (i Cc), U. S. P. 

Extractum Rhamni Purshianae — Extracti Rhamni Purshianaae — Extract 
of Cascara Sagrada (U. S. P ). — One part of the solid extract represents the activity 
of four parts by weight of the bark. 

Dose. — Average dose: 4 grains (0.250 Gm. = 250 milligrammes), U. S. P. 

[This represents 15 grains (1 Gm.) of the bark, and is equal to the Pharmacopceial 
dose of the fluidextract — namely, 15 minims (1 Cc. ).] 

Physiological Action. — Cascara sagrada is a peculiarly efficient 
laxative, although in certain individuals it appears to be inert unless 
associated with other purgatives. The bitter principle it contains 
gives to the drug stomachic properties. 

The action of cascara is seldom attended with irritation or un- 
pleasant symptoms, the drug requiring from six to ten hours to 
operate. 

Therapeutics. — Cascara is a very valuable laxative, being em- 
ployed chiefly to overcome habitual cojistipation due to simple 
torpor of the colon without associated disease. The drug is not 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 523 

adapted for rapid evacuation of the bowels, but rather for regulating 
their action. 

Administration. — The fluid and solid extracts are usually em- 
ployed, although the cascara cordial and the aromatic fluidextract, 
while requiring larger doses, are so palatable that they have be- 
come deservedly popular. 

Whatever be the preparation used in cases of habitual consti- 
pation, it should be given in small but repeated doses, gradually 
diminished until a natural action of the bowels shall have been 
established. The drug should be administered upon an empty 
stomach and in as diluted a condition as possible. 

Magnesii Oxidum— Magnesii Oxidi— Magnesium 
Oxidum. U. S. P. 

(Light Magnesia; Calcined Magnesia.) 

Origin, Description, and Properties given under Alkalies. 
Dose. — 5-60 grains (0.32-4.0 Gm.) [30 grains (2 Gm.), U. S. P.]. 

Magnesii Carbonas— Magnesii Carbonatis— Magne- 
sium Carbonate. JJ. S. J*. 

Origin, Description, and Properties given under Alkalies. 
Dose. — %-2 drams (1.0-8.0 Gm.) [45 grains (3 Gm.), U. S. P.]. 

Physiological Action. — Both magnesia and magnesium car- 
bonate are mild antacid laxatives, requiring the presence of an 
acid in the stomach and bowels to render them active. Occasion- 
ally, when there is marked acidity of the stomach, magnesium 
carbonate occasions flatulence. 

When taken in large amounts or for a long time magnesia tends 
to accumulate in the intestines. This untoward effect may be pre- 
vented by administering lemonade with the drug, the acid of which 
increases the solubility of the magnesia. 

Therapeutics. — Magnesium carbonate as a protective powder 
is an effective agent in the treatment of dermatitis of the external 
auditory passage. The drug is a valuable antidote to counteract 
the effects of phosphorus-poisoning in the throat. 

Both magnesia and magnesium carbonate are mild alkalies, 
and may be used for the same purposes as the alkalies. They are 
serviceable antidotes to poisoning from mineral and oxalic acids 
and many mineral salts. They are pleasant laxatives, being ex- 
tensively employed for children. 

Manna— Mannae— Manna. TT. S. r. 

Origin. — The concrete, saccharine exudation of Fraxinus Ornus L., a slender 
tree indigenous on the northern shore of the Mediterranean from Asia Minor west to 
Spain. 

Description and Properties. — Flattish, somewhat three-edged pieces, about 
8 inches (20 Cm.) long and 2 inches (5 Cm.) broad (usually smaller), friable, exter- 



524 A TEXT-BOOK OF MATERIA MEDICA. 

nally yellowish-white, internally white, porous, and crystalline; or fragments of 
different sizes, brownish-white, and somewhat glutinous on the surface, internally white 
and crystalline ; odor honey-like ; taste sweet, slightly bitter, and faintly acrid. 
Manna contains a resin, the purgative principle, besides mannite, fraxin, and sugar. 

Dose. — y 2 -i ounce (16.0-32.0 Gm.) \}/ 2 ounce (16 Gm.), U. S. P.], dissolved in 
hot water. 

Official Preparation. 

Infusum Sennae Compositum — Infusi Sennae Compositi — Compound Infu- 
sion of Senna. — See Senna. 

Physiological Action and Therapeutics. — Manna is a laxative, 
cholagogue, and nutrient. Its mild laxative action renders the 
drug peculiarly efficient in constipated conditions of pregnant 
women, and children and persons suffering from piles or irritation 
of the genito-urinary tract. 

The drug is slow in its action, tending to confine the bowels 
after the primary laxative effect. 



Sulphur Sublimatum— Sulphuris Sublimati— 
Sublimed Sulphur. U. S. JP. 

Origin. — Obtained from crude sulphur by sublimation. 

Description and Properties. — A fine yellow powder, having a slight char- 
acteristic odor and a faintly acid taste. Insoluble in water; slightly soluble in absolute 
alcohol ; more readily soluble in benzin, benzol, oil of turpentine, and many other oils, 
as well as in ether, chloroform, and boiling aqueous solutions of alkaline hydrates. 

Dose. — 15-60 grains (1.0-4.0 Gm.) [60 grains (4 Gm.), U. S. P.]. 

Official Preparations. 

Sulphur Lotum — Sulphuris Loti — Washed Sulphur. — Origin. — Sublimed 
sulphur, 100 ; water, q. s. ; ammonia water, 10 ; digested, filtered, drained, and dried. 

Description and Properties. — A fine yellow powder, without odor or taste. Insol- 
uble in water, but soluble in the substances which dissolve sulphur. 

Dose. — 15-60 grains (1.0-4.0 Gm. ) [60 grains (4 Gm.), U. S. P.]. 

Unguentum Sulphuris — Unguenti Sulphuris — Sulphur Ointment. — Washed 
sulphur, 150 ; benzoinated lard, 850. For external use. 

Washed sulphur is an ingredient of compound liquorice powder. 

Sulphur Praecipitatum — Sulphuris Praecipitati — Precipitated Sulphur (Milk 
of Sulphur; Lac Sulphur).— Origin. — Sublimed sulphur is boiled with slaked 
lime and water. To the solution is added hydrochloric acid, which throws down 
sulphur as a fine precipitate, the powder being washed and dried. 

Description and Properties. — A fine amorphous powder of a pale-yellow color, 
without odor or taste. Insoluble in water. 

Dose. — 15-60 grains (1.0-4.0 Gm.) [60 grains (4 Gm.), U. S. P.]. 

Physiological Action. — Externally and Locally. — Sulphur is an 
active parasiticide, antiseptic, and keratoplastic agent. Upon the 
skin the drug of itself has no influence ; a portion of it, however, 
is converted into hydrogen sulphide, which acts as a mild cutane- 
ous irritant. 

hiternally. — As observed, sulphur proper has no action either 
externally or locally, although it is a normal constituent of nearly 
all the solids and fluids of the body. When ingested some of it 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 525 

is converted into hydrogen sulphide and other sulphides, which 
increase the intestinal secretions and promote peristalsis. 

The drug is chiefly excreted with the stools, which are rendered 
soft and semiliquid. A portion of the hydrogen sulphide formed 
is eliminated through the kidneys, lungs, skin, and milk-glands. 
The drug is usually found in the urine as a sulphate. 

There is imparted to the breath the offensive odor of hydrogen 
sulphide, and the minute portion eliminated through the skin is suf- 
ficient to discolor silver ornaments in contact with the surface of 
the body. 

While hydrogen sulphide is a powerful poison, decomposing 
the blood and paralyzing the nervous and muscular systems, the 
amount formed and absorbed under the administration of sulphur 
is too small to produce marked toxic symptoms. Even when 
large amounts of sulphur have been ingested, there is produced 
only violent vomiting and purging, a slight elevation of tempera- 
ture, and a distinct odor of hydrogen sulphide in the breath. 

When sulphur is used in full doses for a long time, it tends to 
impair the quality .of the blood and produce muscular weakness. 
Occasionally untoward manifestations, such as miliary eruptions and 
eczema, accompany either the external application or the ingestion 
of the drug. 

As a laxative sulphur is slow and mild, although it occasionally 
causes considerable flatus, in some cases rendering the drug objec- 
tionable as a purgative. 

Therapeutics. — Externally and Locally. — While classed among 
laxative drugs, sulphur is a most efficient remedy in many diseases 
of the skin, nose, throat, etc., the external uses of sulphur being 
very numerous. 

The drug is perhaps the most serviceable parasiticide we possess 
in scabies, sulphur ointment well rubbed into the skin being usually 
sufficient to destroy the parasite. 

Even diseases induced by vegetable parasites, such as tinea 
versicolor, etc., are cured by inunctions of sulphur ointment. 

The drug is successfully employed in the treatment of infil- 
trated eczema, impetigo, sycosis, ecthyma, acne, comedo, and psoriasis. 

The flowers of sulphur is an old domestic remedy, and quite 
an efficient one, in diphtheria and pharyngitis. Finally, Coroden 
and Duchane have both reported the successful treatment of 
sciatica by enveloping the affected limb in precipitated sulphur, 
the profuse sweating induced being followed by a decided allevi- 
ation of pain. 

When sulphur is burned in moist air sulphur dioxide is formed, 
which, if large quantities are confined in a small space and added 
to moist steam, is a fair disinfectant. It is probable that the 
old-fashioned methods of sulphur fumigation are little short of 
being farcical. 

Internally.— -The principal internal use of sulphur is as a mild 



526 A TEXT-BOOK OF MA TERIA MEDICA. 

laxative, the drug being especially indicated for persons afflicted 
with hemorrhoids or mi al fissure. 

Lozenges are prepared containing sulphur and cream of tartar, 
which, if taken daily for some time, will overcome habitual consti- 
pation. 

Sulphur has been used internally, and occasionally with con- 
siderable success, in bro?ichitis, chronic rheumatism, and eczema 
attended with much itching. 

Administration. — Sulphur may be given in the form of loz- 
enges or mixed with molasses — either alone or associated with cream 
of tartar, which is said to enhance the action of sulphur. Milk 
and syrup have been used as vehicles in the administration of the 
drug. 

Sulphurous baths, both natural and artificial, have been em- 
ployed in the treatment of rheumatism, gout, and some cutaneous 
affections. Not only for these purposes, but for their laxative 
influence as well, sulphurous waters are held in great repute. 

Taraxacum— Taraxaci— Taraxacum. V. S. I*. 

(Dandelion.) 

Origin. — The dried root of Taraxacum officinale Weber, a perennial, acaulescent 
herb found in most countries of the northern hemisphere. 

Description and Properties. — Slightly conical, about 12 inches (30 Cm.) 
long and ^ to 1 inch (12-25 Mm.) thick above, crowned with several short, thickish 
heads, somewhat branched, dark-brown, longitudinally wrinkled ; when dry breaking 
with a short fracture, showing a yellowish, porous central axis surrounded by a thick 
white bark containing numerous milk-vessels arranged in concentric circles ; inodorous ; 
bitter. 

The drug contains a bitter principle, taraxacin, besides innlin, resin, sugar, and 
mucilaginous substances. 

Dose. — 1-4 drams (4.0-15 o Gm.) [2 drams (8 Gin.), U. S. P.]. 

Official Preparations. 

Extractum Taraxaci — Extracti Taraxaci — Extract of Taraxacum. — Dose, 
5-60 grains (0.3-4.0 Gm.) [15 grains (1 Gm.), U. S. P.]. 

Fluidextractum Taraxaci — Fluidextracti Taraxaci — Fluidextract of Tarax- 
acum. — Dose, 1-4 fluidrams (4.0-15.0 Cc. ) [2 fluidrams (8 Cc), U. S. P.]. 

Physiological Action and Therapeutics. — Taraxacum is a 
stomachic tonic, diuretic, laxative, cholagogue, and feeble hepatic 
stimulant. It has been a popular remedy for constipation associated 
with hepatic congestion and atonic dyspepsia, yet the drug is now less 
employed than formerly, in actual practice being usually united 
with other laxatives. 

The extract or fluidextract may be given, the latter and the 
expressed juice being the more active. 

SIMPLE PURGATIVES. 

These differ from laxatives only in degree, the former being 
more active, exciting greater peristaltic action and causing a larger 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 527 

secretion from the intestinal glands. Simple purgatives usually oc- 
casion one or more copious and somewhat liquid stools, frequently 
accompanied by considerable irritation and griping. 

Aloe— Aloes— Aloes. U. S. P. 

Origin. — The inspissated juice of the leaves of Aloe vera (L.) Webb; Aloe 
Perryi Baker, Aloe Chinensis Baker, or other species of Aloe, plants resembling the 
so-called century plant {Agave Americana), indigenous in India and Northeastern 
Africa, and naturalized along the shores of the Mediterranean and in the West Indies. 

Dose. — 2 -10 g rains (0.03-0.6 Gm.). 

Official Preparations. 

Extractum Aloes — Extracti Aloes — Extract of Aloes. — Dose, \-d grains 
(0.03-0.4 Gm.) [2 grains (0.125 Gm. ), U. S. P.]. 

Aloe Purificata — Aloes Purificatae — Purified Aloes. — Dose, \-\o grains (0.03- 
0.6 Gm.) [4 grains (0.25 Gm.),.U. S. P.]. 

Pilulae Aloes — Pilulas (ace.) Aloes — Pills of Aloes. — Dose, 1 to 4 pills. 

Pilulae Aloes et Ferri — Pilulas (ace.) Aloes et Ferri — Pills of Aloes and 
Iron. — Each pill contains about 1 grain (0.07 Gm.), each, of aloes, dried ferrous sul- 
phate, and aromatic powder. 

Dose. — 1 to 4 pills. 

Pilulae Aloes et Mastiches — Pilulas (ace.) Aloes et Mastiches — Pills of 
Aloes and Mastich. — Each pill contains about 2 grains (0.13 Gm.), together with 
mastich and red rose (Lady Webster's Dinner Pill). 

Dose. — 1 to 3 pills. 

Pilulas Aloes et Myrrhae — Pilulas (ace.) Aloes et Myrrhae — Pills of Aloes 
and Myrrh. — Each pill contains 2 grains (0.13 Gm.), together with myrrh and aro- 
matic powder. 

Dose. — 1 to 3 pills. 

Pilulas Rhei Compositae — Pilulas (ace.) Rhei Compositas — Compound Pills 
of Rhubarb. — Each pill contains \]/ 2 grains (o. 10 Gm.) of aloes. 

Dose. — 1 to 3 pills. 

Pilulas Laxativae Compositae — Pilulas Laxatives Compositas — Compound 
Laxative Pills (U. S. P.). — Each pill contains \ grain (a.013 Gm. = 13 milli- 
grammes) aloin, jij grain (0.0005 Gm. = o.5 milligramme) strychnine, }£ grain (0.008 
Gm. = 8 milligrammes) extract of belladonna leaves, and T ^ grain (0.004 Gm. =4 milli- 
grammes) of ipecac. 

Dose. — Average dose : 2 pills (U. S. P.). 

Pilulae aloini, strychninse et belladonnas (N. F.), contain, withthe exception of the 
ipecac, the same active ingredients and in the same proportions (Hunt). 

Tinctura Aloes — Tincturae Aloes — Tincture of Aloes (10 per cent.). 

Dose. — %-i fluidram (2.0-4.0 Cc.) [30 minims (2 Cc. ), U. S. P.]. 

Tinctura Aloes et Myrrhae — Tincturae Aloes et Myrrhae — Tincture of Aloes 
and Myrrh (10 per cent, of each, with glycerin 10 per cent.). 

Dose. — 1-2^ fiuidrams (2.0-10.0 Cc.) [80 minims (2 Cc), U. S. P.]. 

Tinctura Benzoini Composita — Tincturae Benzoini Compositas — Compound 
Tincture of Benzoin (2 per cent, of aloes). 

Dose. — 10-40 minims (0.6-2.6 Cc.) [30 minims (2 Cc), U. S. P.]. 

Aloinum — Aloini — Aloin (U. S. P.). — Origin. — A neutral principle obtained 
from several varieties of aloes. 

Description and Properties. — Minute acicular crystals or a micro-crystalline pow- 
der, varying in color from yellow to yellowish-brown ; odorless or possessing a slight 
odor of aloes, of a characteristic, bitter taste, and permanent in the air. 

Dose. — ]/ z -2. grains (0.03-0.12 Gm. ) [1 grain (0.065 Gm.), U. S. P.]. 

Extractum Colocynthidis Compositum — Extracti Colocynthidis Compositi 
— Compound Extract of Colocynth. — Dose, 5-25 grains (0.3-1.6 Gm.) {j l / 2 grains 
(0.5 Gm.), U. S. P.]. (See Colocynth.) 

Physiological Action. — Aloes has no local action, although 
the drug is readily absorbed from ulcers or abraded surfaces. 



528 A TEXT-BOOK OF MATERIA MEDIC A. 

Internally it is stomachic, increasing the secretions from the 
gastro-intestinal tract. It probably increases the secretion of bile. 
Its principal action appears to be upon the colon, the muscular 
coat of which it stimulates, in addition to augmenting the secretion 
from the large intestine. 

In from ten to fifteen hours after the ingestion of the drug it 
causes soft, dark-colored evacuations, its action being usually 
attended with more or less griping pain. 

The blood-supply to the lower bowel and pelvic viscera is 
increased by aloes ; and the drug, if used habitually, may bring 
on or aggravate hemorrhoids. The menstrual function is stimu- 
lated, the drug being a decided emmenagogue. 

Aloes is readily absorbed ; it is eliminated through the bowels 
and kidneys, and is found also in the milk. 

Therapeutics. — The principal use of aloes is as a purgative in 
habitual constipation due to a torpid condition of the large intestine. 
Jaundice resulting from gastro-intestinal catarrh is well treated 
with aloes and blue pill. 

Pills of aloes and iron are useful adjuvants to other remedies 
in the treatment of chlorosis. Amenorrhea,! which is such a common 
condition in chlorosis, is relieved by aloes. Pills of aloes and iron 
are equally valuable in menorrhagia arising from debility. 

Contraindications. — Aloes is ordinarily contraindicated in hem- 
orrhoids, although those cases attended with a mucous discharge 
are frequently benefited by it, The drug is considered objection- 
able in pregnancy, in persons of plethoric, bilious, or hemorrhagic 
constitution, and in menorrhagia of the strong and full-blooded. 

Administration. — When desired as a purgative, aloes in pill 
form is preferable to the liquid preparations, and the drug may 
be given alone or associated with other purgatives, tonics, or 
antispasmodics. 

Aloin is perhaps to be preferred to aloes, as it gripes less and 
may be given in smaller doses. It is less certain, however. 

Fel Bovis— Fellis Bovis— Oxgall. 77. S. J*. 

Origin. — The fresh bile of Bos Taurus L. 

Description and Properties. — A brownish-green or dark-green, somewhat 
viscid liquid, having a peculiar, unpleasant odor and a disagreeable, bitter taste. 
Dose.— 5-15 grains (0.3-1.0 Gm.). 

Official Preparation. 

Fel Bovis Purificatum — Fellis Bovis Purificati — Purified Oxgall. — Descrip- 
tion and Properties. — A yellowish-green, soft solid, having a peculiar odor and a partly 
sweet and partly bitter taste. Very soluble in water and in alcohol. 

Dose. — 5-15 grains (0.3-1.0 Gm.) [y\ grains (0.5 Gm.), U. S. P.]. 

Physiological Action and Therapeutics. — Like bile, oxgall 
augments the duodenal secretions, emulsionizes fats, and increases 
intestinal peristalsis. It renders bile more fluid, and acts as a 
cholagogue and purgative. It is a useful cathartic when the stools 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 529 

are very offensive and of a light-clay color, indicating a deficient 
biliary secretion. The drug is serviceable in jaundice due to 
obstruction of the common duct by inspissated bile or mucus. 
Impacted feces are readily removed by an enema containing 1 5 or 
20 grains (1.0-1.3 Gm.) of oxgall. The drug is an efficient intes- 
tinal antiseptic, and may be beneficially employed for that purpose 
in typhoid fever and intestinal fermentation. 
Oxgall is usually given in pill form. 

Rheum— Rhei— Rhubarb. XT. S. r. 

Definition. — The dried rhizome of Rheum officinale Baillon, Rheum palmatum 
L. , and the var. tanguticum Max. or other species of Rheum, grown in China or 
Thibet, and deprived of most of the bark and carefully dried. 

Description and Properties. — In cylindrical, conical, or flattish segments, 
deprived of the dark-brown, corky layer, smoothish or somewhat wrinkled, externally 
covered with a bright yellowish -brown powder, marked with white, elongated meshes, 
containing a white, rather spongy tissue, and a number of short, reddish-brown or 
brownish-yellow striae ; compact, hard ; fracture uneven ; internally white, with 
numerous red, irregularly-curved, and interrupted medullary rays, which are radially 
parallel only near the cambium line ; odor somewhat peculiar, aromatic ; taste bitter, 
somewhat astringent. When chewed, rhubarb feels gritty between the teeth and 
imparts a yellow color to the saliva. Rhubarb which is very porous, or has a promi- 
nently mucilaginous taste, or is of a dark -brown color internally, should be rejected. 

The drug contains the following constituents : chrysophan (and chrysophanic 
acid), emodin, imperfectly isolated glycosides as cathartin, or cathartinic acid, rheo- 
tannic acid, starch, calcium oxalate, etc, 

Dose. — 5-30 grains (0.32-1,94 Gm.) [15 grains (i Gm.), U. S. P.]. 

Official Preparations, 

Extractum Rhei — Extracti Rhei — Extract of Rhubarb. — Dose, 3-15 grains 
(o. 19-1.0 Gm.) [4 grains (0.25 Gm. ), U. S. P.]. 

Fluidextractum Rhei — Fluidextracti Rhei — Fluidextract of Rhubarb. — 
(This preparation is used in Mistura Rhei et Soda? and in Syrupus Rhei). 

Dose. — 5-30 minims (0.3-2.0 Cc.) [15 minims (1 Cc. ), U. S. P.], 

Pilulae Rhei Compositae — Pilulas (ace.) Rhei Compositas— Compound 
Rhubarb Pills. — Each pill contains about 2 grains (0.12 Gm. ) of rhubarb, with puri- 
fied aloes 1%, grains (0.09 Gm.), myrrh, and oil of peppermint. 

Dose. — 1 to 3 pills. 

Pulvis Rhei Compositus — Pulveris Rhei Compositi — Compound Rhubarb 
Powder (Gregory's Powder). — (25 per cent, with magnesia and ginger). 

Dose. — y 2 -\ dram (2.0-4.0 Gm.) [30 grains (2 Gm.), U. S. P.]. 

Tinctura Rhei — Tincturae Rhei — Tincture of Rhubarb. — (20 per cent., with 
cardamom). 

Dose. — ^-4 fiuidrams (2.0-15.0 Cc.) [1 fiuidram (4 Cc), U. S. P.]. 

Tinctura Rhei Aromatica — Tinctura Rhei Aromaticae— Aromatic Tincture 
of Rhubarb. — (20 per cent., with cassia, cinnamon, cloves, and nutmeg). 

Dose. — 1-3 fiuidrams (4.0-120 Cc.) [30 minims (2 Cc), U. S. P.]. 

This preparation is used to make syrupus rhei aromaticus. 

Mistura Rhei et Sodae — Misturae Rhei et Sodas — Mixture of Rhubarb and 
Soda. — Formula: Sodium bicarbonate, 35: fluidextract of rhubarb, 15; fluidextract 
of ipecac, 3 ; glycerin, 350 ; spirit of peppermint, 35 ; water, to 1000. 

Dose.— %-2 fluidounces (8 0-60.0 Cc.) [1 fiuidram (4 Cc), U. S. P.]. 

Syrupus Rhei — Syrupi Rhei — Syrup of Rhubarb. — Formula: Fluidextract 
of rhubarb, 100 ; potassium carbonate, 10 ; spirit of cinnamon, 4 ; water, 50 ; syrup, 
to 1000. 

Dose — 1-4 fiuidrams (4.0-15.0 Cc.) [2 fiuidrams (8 Cc), U. S. P.]. 

Syrupus Rhei Aromaticus— Syrupi Rhei Aromatici — Aromatic Syrup of 
Rhubarb. — Formula : Aromatic tincture of rhubarb, 150 ; potassium carbonate 
syrup, 850. 

Z)ose.—y 2 -2 fiuidrams (2.0-8.0 Cc.) [2 fiuidrams (8 Cc), U. S. P.]. 

34 



530 A TEXT-BOOK OF MATERIA MEDICA. 

Physiological Action and Therapeutics. — Rhubarb in mod- 
erate doses is a stomachic, acting similarly to the aromatic bitters, 
increasing secretion, peristalsis, vascularity, and absorption, thereby 
aiding digestion and serving as a tonic. In larger doses it is a 
mild cathartic, producing in from four to eight hours a soft yellow- 
ish-brown evacuation, not watery, which is not infrequently accom- 
panied by griping. 

After full doses of rhubarb have been taken the purgative action 
is succeeded by quiescence of the bowels, the constipation being 
the result of the action of the astringent constituents of the rhu- 
barb. Small doses, however, taken daily, serve a useful purpose 
in relieving habitual constipation without in the least impairing 
digestion. 

The drug is excreted with the feces, urine, perspiration, and 
milk ; the urine is slightly increased in amount and, together 
with the perspiration and milk, is colored yellow. The milk 
acquires a bitter taste and purgative properties. 

Rhubarb is one of the best purgatives for children suffering 
from diarrhea caused by irritating ingesta in the bowels or to cold ; 
it is also of value in some cases of dysentery. Summer diarrhea 
of children is often cured by some preparation of rhubarb alone, 
the diarrhea ceasing after a free purge by the drug. 

As a simple laxative for children it is a valuable remedy, owing 
to its secondary tonic and astringent effects, and is recommended 
as a laxative to expel thread-worms. 

When hemorrhoids are connected with constipation, much relief 
may be obtained by the gentle action of rhubarb. 

Administration. — Rhubarb is seldom given alone, because of 
the griping it occasions. For children the syrups are excellent 
preparations, and the mixture of rhubarb and soda is an appropri- 
ate remedy when the secretions of the stomach and bowels are 
unduly acid. 

In habitual constipation of adults the simple rhubarb pill is an 
efficient preparation. 

The choice of the preparation will depend largely upon the 
individual case. 



Euonymus— Euonymi— Euonymus. TJ. S. P. 

(Wahoo. ) 

Origin. — The dried bark of the root of Euonymus atropurpureus Jacquin, a 
shrub 6 to io or 14 feet (1.8-3 or 4.2 M.) high, found growing in shady woods of 
the northern and middle section of the United States, east of the Mississippi. 

Description and Properties. - In quilled or curved pieces y 1 ^ to \ inch (2-5 
Mm.) thick ; outer surface ash-gray, with blackish patches, detached in thin and small 
scales; inner surface whitish or slightly tawny, smooth; fracture smooth, whitish, the 
inner layers of a laminated appearance ; nearly inodorous ; taste sweetish, somewhat 
bitter and acrid. 

The chief constituent of the drug is a glycoside, euonymin. 

Dose. — 1-2 drams (40-8.0 Gm.) [7.] grains 10.5 Gm.), U. S. P.], 



DRUGS ACTING ON GAS TRO-INTES TINA L ORGANS. 531 
Official Preparations. 

Extractum Euonymi — Extracti Euonymi — Extract of Euonymus. — Dose, 
1-5 grains (0.06-0.3 Gm.) [2 grains (0.125 Gm. ), U. S. P.J. 

Fluidextractum Euonymi — Fluidextracti Euonymi — Fluidextract of Eu- 
onymus (U. S. P.). — The solid extract of euonymus, which was already official, is 
now prepared from this fluidextract. 

Dose. — Average dose: 8 minims (0.5 Cc. ), U. S. P. 

Physiological Action and Therapeutics. — Euonymus resem- 
bles rhubarb in its action, but is milder, small doses being stimu- 
lant to the stomach. The drug is an active hepatic stimulant, 
increasing the secretion of bile and facilitating its excretion into the 
intestine. It is excreted by the kidneys and bronchopulmonary 
mucous membrane, being a mild diuretic and expectorant. Euony- 
mus is an excellent cathartic, particularly in cases of constipation 
attended with impaired functional activity of the liver. 

Euonymin is an impure resin, and is not yet reliable. The offi- 
cial fluidextract of euonymus is a reliable preparation. 

Leptandra— Leptandrae— Leptandra. U. S. 1*. 

(Culver's Root.) 

Origin. — The dried rhizome and roots of Veronica virginica L., a plant indige- 
nous in Canada, and in the United States as far west as the Mississippi Valley. 

Description and Properties. — Of horizontal growth, from 4 to 6 inches 
(10-15 Cm.) long and about ~% inch (6 Mm.) thick, somewhat flattened, bent and 
branched, deep blackish-brown, with cup-shaped scars on the upper side, hard, of a 
woody fracture, with a thin, blackish bark, a hard, yellowish wood, and a large, 
purplish-brown, about six-rayed pith ; roots thin, wrinkled, very fragile ; inodorous ; 
taste bitter and feebly acrid. 

Leptandra contains a crystalline glycoside, leptandrin, besides tannin, gum, and a 
small quantity of volatile oil. 

Dose. — 15-60 grains (1.0-4.0 Gm.) [15 grains (1 Gm.), U. S. P.]. 

Official Preparations. 

Extractum Leptandrae — Extracti Leptandrae — Extract of Leptandra. — 

Dose, 1-5 grains (0.06-0.3 Gm. ) [4 grains (0.25 Gm.), U. S. P.]. 

Fluidextractum Leptandrae — Fluidextracti Leptandrae — Fluidextract of 
Leptandra. — Dose, 15-60 minims (1.0-4.0 Cc.) [15 minims (1 Cc. ), U. S. P.]. 

The Pilulae Catharticae Vegetables contain % grain (o.oi Gm.) of the extract 
of leptandra to each pill. 

Leptandrin (non-official). — Dose, 1-3 grains (0.06-0.2 Gm. ). An impure 
mixture of resins is on the market. 

Physiological Action and Therapeutics. — The action of lep- 
tandra is similar to the actions of euonymus, iris, and juglans, the 
green root, however, being more of an irritant to the gastrointes- 
tinal tract, possessing marked emetocathartic properties. 

It is thought to be an active hepatic stimulant, and may be 
advantageously employed for the same purposes as euonymus, 
iris, etc. 

Senna— Sennae— Senna. TT. S. P. 

Origin. — The dried leaflets of Cassia acutifolia Delile (Alexandria senna) or of 
Cassia angustifolia Vahl (India senna), small shrubs found in Upper Egypt and south- 
ward to Nubia, Sennaar, and Kordofan, and farther westward in tropical Africa 



532 A TEXT- BOOK OF MATERIA MEDIC A. 

[Cassia aculifolia), and in Southwestern Arabia, along the Somali coast of Africa, and 
eastward in Northern India [Cassia angustifolid) . 

Description and Properties. — Alexandria senna consists of leaflets about I 
inch (25 Mm.) long and f inch (10 Mm.) broad, lanceolate or lance-oval, subcori- 
aceous, brittle, rather pointed, unequally oblique at the base, entire, grayish-green, 
somewhat pubescent ; of a peculiar odor, and a nauseous, bitter taste. 

India senna consists of leaflets I to 2 inches (2.5-5 Cm.) long and | to \ inch 
(10-15 Mm.) broad, lanceolate, acute, unequally oblique at the base, entire, thin, 
yellowish-green or dull-green, nearly smooth; odor peculiar, somewhat tea-like; taste 
mucilaginous, bitter, and nauseous. 

Senna contains a sulphuretted glycosid, cathartic acid, to which the purgative 
properties of the drug are due. Senna also contains chrysophan, besides sennacrol 
and sennapicrin (two bitter principles), catharto-mannite, mucilage, etc. 

Dose. — 10 grains to 3 drams (0.6-12.0 Gm.) [60 grains (4 Gm.), U. S. P.], 

Official Preparations. 

Confectio Sennae — Confectionis Sennae — Confection of Senna. — 10 per cent, 
with cassia fistula, tamarind, prune, fig, sugar, and oil of coriander. Dose, 1-3 drams 
(4.0-12.0 Gm.) [60 grains (4 Gm. ), U. S. P.]. 

Fluidextractum Sennse — Fluidextracti Senna — Fluidextract of Senna. — 
Dose, 10 minims to 3 fluidrams (0.6-1 1.09 Cc.) [30 minims (2 Cc), U. S. P.]. 

Infusum Sennae Compositum — Infusi Sennae Compositi — Compound Infu- 
sion of Senna. — 6 per cent., with manna and magnesium sulphate, each 12 per cent., 
and fennel 2 per cent. Dose, 1-2^ fluidounces (30.0-75.0 Cc.) [4 ounces (120 Cc), 
U. S. P.]. 

Pulvis Glycyrrhizae Compositus — Pulveris Glycyrrhizae Compositi — Com- 
pound Powder of Glycyrrhiza. — Formula : Senna, 180 ; glycyrrhiza, 236 ; oil of 
fennel, 4 ; washed sulphur, 80 ; sugar, 500. 

Dose. — y z -i drams (2.0-8.0 Gm.) [60 grains (4 Gm.), U. S. P.]. 

Syrupus Sennae — Syrupi Sennae — Syrup of Senna (25 per cent.). — Dose. 
— ]^-\ fluidounce (8.0-30.0 Cc.) [1 fluidram (4 Cc), U. S. P.J. 

Syrupus Sarsaparillae Compositus contains 15 per cent, of the fluidextract of 
senna. 

Dose.— 4 drams (16 Cc), U. S. P. 

Physiological Action and Therapeutics. — Senna is an active 
purgative, acting upon nearly the entire intestinal tract, increasing 
both peristalsis and intestinal secretion, although having but little 
effect upon the biliary secretion. It is apt to occasion much flatu- 
lence and griping unless it is associated with aromatics. Full doses 
open the bowels in from four to eight hours, producing one or 
more copious liquid, yellow stools, but never occasioning hyper- 
catharsis, and the purgation is not followed by constipation. 

An infusion of senna, if injected into the veins, excites both 
vomiting and purging. 

Some persons are so susceptible to the influence of senna as to 
be purged even by its odor. 

The drug, or some constituent of it, is eliminated by the urine, 
to which it imparts a red color, and by the milk, rendering it pur- 
gative. 

The various preparations of senna are very efficient purgatives 
in cases of simple constipation or in cases of fecal accumulation in 
the colon. 

Infusion of senna is an admirable purgative with which to suc- 
ceed the administration of blue pill. In cases of biliousness there is 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 533 

probably no better treatment than calomel or blue pill at night and 
infusion of senna in the morning. 

Habitual constipation and the constipation of pregnancy are. safely 
and agreeably treated by compound liquorice powder. 

Administration. — Senna is seldom given alone, but is generally 
associated with some corrective to prevent griping. 

The infusion, compound liquorice powder, syrup, and confection 
of senna are employed. 

The compound liquorice powder and the confection being the 
mildest and pleasantest, the latter preparation, when coated with 
chocolate, is readily taken by children, and in this form is the well- 
known laxative " Tamar Indien." Many of the household teas and 
proprietary laxatives contain senna. The laity should be cautioned 
against their use. 

HYDRAGOGUE PURGATIVES. 

These drugs are more active than the preceding class, pro- 
ducing an abundant secretion from the intestinal mucous mem- 
brane, removing a large quantity of water from the blood-vessels, 
and producing several copious, watery stools. 

Oleum Tigrlii— Olei Tiglii— Croton Oil. U. S. P. 

Origin. — A fixed oil expreesed from the seed of Croton Tiglium L., indigenous 
in Hindustan and some of the East Indian and Philippine islands. 

Description and Properties. — A pale-yellow or brownish-yellow, somewhat 
viscid, and slightly fluorescent liquid, having a slight, fatty odor and a mild, oily, 
afterward acrid and burning taste ( great caution is necessary in tasting) . Croton oil 
should be kept in small, well-stoppered bottles, and should be handled with caution, 
for when applied to the skin it produces rubefaction or a pustular eruption. 

When fresh, croton oil is soluble in about 60 parts of alcohol, the solubility 
increasing by age. 

Croton oil is broken up into crotonoleic acid which resembles in its action ricin- 
oleic acid, but is much more powerful. 

Dose. — /^-2 minims (0.01-0. 12 Cc.) on a lump of sugar or mixed with some 
bland oil [1 minim (0.05 Cc), U. S. P.]. 

Physiological Action. — Externally and Locally. — Croton oil is 
a powerful irritant when applied to the skin, exciting inflammation 
and quickly producing vesication, which rapidly merges into pus- 
tules closely resembling those of variola, and perhaps lasting 
several days. In many cases permanent cicatrices mark the sites 
of these pustules. 

If the drug be rubbed over the abdomen, it may produce pur- 
gation. The irritating action is wholly due to the free croton- 
oleic acid which the oil contains. 

Internally. — When a drop or two of croton oil is taken into the 
stomach it occasions a sense of heat in the epigastrium, which is 
soon succeeded by griping and abdominal pain, and in from half 
an hour to two hours after the ingestion of the drug there are pro- 
duced profuse watery stools, with considerable burning and irrita- 
tion about the anus. 



534 A TEXT-BOOK OF MA TERIA MEDICA. 

The drug greatly increases the vascularity of, and the secretion 
from, the gastro-intestinal tract, without specially influencing the 
biliary secretion. 

Large doses produce violent gastro-enteritis, hypercatharsis, 
with great prostration and collapse resembling that of cholera. 

In case of poisoning the stomach should be immediately evacu- 
ated, and demulcent drinks freely given. Opium and stimulants 
may be necessary. 

Therapeutics. — Externally and Locally. — The external use of 
croton oil is comparatively limited. 

Croton oil has been put to many uses, but the results obtained 
are so unsatisfactory that it is needless to enumerate them. 

Internally. — The drug is used as a purgative, as a rule, only in 
cases of emergency, and then a single dose is usually sufficient. 
It is employed in such cases as intestinal obstruction from accumu- 
lated feces produced by torpor of the bowels, diseases of the nervous 
system, lead-poisoning, etc. In lead colic it is probably superior to 
all other purgatives. 

Croton oil is sometimes employed for its revulsive action in 
apoplexy. 

As a purgative it is frequently given to the insane, because, on 
account of the smallness of the dose, it may be easily placed on 
the back of the tongue, where it is quickly swallowed reflexly. 

Contraindications. — The drug should never be given to preg- 
nant women, to children, nor to patients suffering from hemor- 
rhoids, peritonitis, gastritis, or enteritis. 

Administration. — Croton oil may be given in emulsion, or 
mixed with some bland oil, or dropped on a piece of loaf sugar, or 
in pill form. 

The best excipient for pills of croton oil is breadcrumb. 

Elaterinum— Elaterini— Elaterin. U. S. P. 

Origin. — A neutral principle obtained from elateriam, a substance deposited by 
the juice of the fruit or Ecballium elaterium L., commonly known as " squirting 
cucumber," a vine growing in the Mediterranean regions of Europe, Africa, and Asia. 

Description and Properties. — Minute, white, hexagonal scales or prismatic 
crystals, without odor, and having a slightly acrid, bitter taste ; permanent in the air ; 
soluble in 4250 parts of water and 337 parts of alcohol, 

Dose. — 3V-T2 g ra i n (0.002-0.005 Gm. ) [-j^ grain (0.005 Gm.), U. S. P.]. 

Official Preparation. 

Trituratio Elaterini — Triturationis Elaterini — Trituration of Elaterin. — 
Dose, about ^ grain (0.05 Gm.) \_ l / 2 grain (0.03 Gm.), U. S. P.]. 

Physiological Action and Therapeutics. — Elaterin is the most 
powerful hydragogue purgative known. 

The drug greatly increases the salivary, gastric, and intestinal 
secretions, as well as those from the liver and pancreas. 

It is a violent purgative, whether given internally or injected 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 535 

subcutaneously, producing abundant watery evacuations attended 
with much griping pain and great prostration. 

Elaterin is indicated where profuse serous discharges are de- 
sired, as in cases of congestion of the brain and lungs, ascites, and 
chronic fiephritis. 

Contraindications. — The drug is not permissible in inflamma- 
tory conditions of the gastro-intestinal tract, nor in pregnancy, 
and it should be administered with much care, if at all, in heart 
disease. 

Administration. — The drug may be given in pill form, in alco- 
holic solution, or in the form of the trituration. Elaterin varies 
greatly in strength, which suggests caution in its use. 



Cambogia— Cambogiae— Gamboge. TJ. 8. P. 

Origin. — A gum-resin obtained from Garcinia Hanburii Hooker Alius, a medium- 
sized tree, indigenous in Siam, Cambodia, and Cochin-China. 

Description and Properties. — In cylindrical pieces, sometimes hollow in 
the center, I to 2 inches (2-5 Cm.) in diameter, longitudinally striate on the surface ; 
fracture flattish-conchoidal, of a waxy luster, orange-red ; in powder bright yellow; 
inodorous ; taste very acrid ; the powder sternutatory. Gamboge is partly soluble in 
alcohol and ether. Cambogic acid is thought to be its active principle. 

Dose. — 1-5 grains (0.06-0.32 Gm.) [2 grains (0.125 Gm.), U. S. P.]. 

Official Preparation. 

Piluise Catharticae Compositas — Pilulas (ace.) Catharticas Compositas — 
Compound Cathartic Pills. — Dose, 1-3 pills. 

Physiological Action and Therapeutics. — Gamboge is a vio- 
lent hydragogue purgative, exciting active peristalsis and greatly 
augmenting the secretion from the intestinal glands, although not 
increasing the secretion of bile. Small and repeated doses are 
slightly diuretic, coloring the urine yellow. 

Gamboge is seldom given alone, being usually associated with 
other purgatives. It is used in combination when a hydragogue 
action by the kidneys, as well as the bowels, is desired. It is 
thought to be of use in hepatic congestion arising from malarial 
causes. The drug is an efficient anthelmintic, and is occasionally 
prescribed with vermicide medicines. 



Colocynthis— Colocynthidis— Colocynth. U. 8. J\ 

Origin. — The peeled, dried fruit of Citrullns Colocynthis Schroder. The colo- 
cynth plant is indigenous in Japan, and is cultivated and naturalized in Spain. 

Description and Properties.— From 2 to 4 inches (5-10 Cm. ) in diameter ; 
globular ; white or yellowish white, light, spongy ; readily breaking into three wedge- 
shaped pieces, each containing, near the rounded surface, many flat, ovate, brown 
seeds ; inodorous ; taste intensely bitter. 

The active constituent of colocynth is colocynthin, a glycosid, of which there is 
present about 2 per cent. Colocynth also contains resin, gum, and an amyloid principle. 

Dose. — 5-10 grains (0.3-0.6 Gm.) [i grain (0.065 Gm. ), U. S. P.]. 



536 A TEXT-BOOK OF MATERIA MEDIC A. 

Official Preparations. 

Extractum Colocynthidis — Extracti Colocynthidis — Extract of Colocynth. 

— Dose. — \-2 grains (0.03-0.13 Gm.) [^ grain (0.03 Gra.), U. S. P.]. 

Extractum Colocynthidis Compositum — Extracti Colocynthidis Compositi 
— Compound Extract of Colocynth. — Extract of colocynth, 16 per cent., with aloes, 
scammony, cardamom, and soap. 

Dose. — 5-25 grains (0.3-1.6 Gm. ) \p]\ grains (0.5 Gm. ), U. S. P.]. 

Compound extract of colocynth enters into the following pills: 

Pilulae Catharticae Compositae (8 per cent.). 

Pilulae Catharticae Vegetabiles (6 per cent.). 

Physiological Action and Therapeutics. — The action of colo- 
cynth is very similar to that of elaterin. In small doses, however, 
it acts as a stomachic, improving the appetite and augmenting 
the secretions of the whole gastro-intestinal tract. Colocynth is a 
decided cholagogue. 

Pills containing colocynth are useful to produce abundant 
watery evacuations, as is necessary sometimes in the treatment of 
hepatic and renal diseases where there is constipation and ascites. 

The drug should be employed only when there is some marked 
indication for its use, as colocynth, like the other drastics, is too 
irritant for habitual use. 

Gastro-intestinal inflammation, pregnancy, etc., would contra- 
indicate its use. 

Jalapa— Jalapae— Jalap. TJ. S. jP. 

Origin. — The dried tuberous root of Exogonium ptirga (Wend.) Bentham, yield- 
ing not less than 8 per cent, of total resin, but not more than 1.5 per cent, of resin 
soluble in ether. Jalap is a twining herbaceous perennial, growing in damp and shady 
woods on the eastern slope of the Mexican Andes. It has been introduced into India 
and Jamaica. 

Description and Properties. — Napiform, pyriform, or oblong, varying in 
size, the large roots incised, more or less wrinkled, dark brown, with lighter-colored 
spots and short transverse ridges ; hard, compact, internally pale-grayish brown, with 
numerous concentric circles composed of small resin-cells; fracture resinous, not 
fibrous ; odor slight, but peculiar, smoky, and sweetish ; taste sweetish and acrid. 

Jalap contains two glycosides, jalapin and convolvulin, which are the active prin- 
ciples of the drug. 

Dose. — 5-30 grains (0.32-2.0 Gm.) [15 grains (1 Gm.), U. S. P.]. 

Official Preparations. 

Pulvis Jalapae Compositus — Pulveris Jalapae Compositi— Compound Jalap 
Powder (35 per cent., with potassium bitartrate). — Dose, 15-60 grains (1.0-4.0 Gm. ) 
[30 grains (2 Gm.), U. S. P.]. 

Resina Jalapae — Resinae Jalapae — Resin of Jalap. — Description and Properties. 
— Yellowish-brown or brown masses or fragments, breaking with a resinous, glossy 
fracture, translucent at the edges, or a yellowish-gray or yellowish-brown powder, 
having a slight peculiar odor, and a somewhat acrid taste. Permanent in the air. 
Soluble in alcohol in all proportions. 

Dose. — 2-5 grains (0.13-0.3 Gm. ) [2 grains (0.125 Gm.), U. S. P.], 

Extract of jalap is one of the ingredients of Pilulae Catharticae Compositae and 
Pilulae Catharticae Vegetabiles. 

Physiological Action and Therapeutics. — The purgative 
action of jalap is developed in the duodenum, where it comes in 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 537 

contact with the bile. The secretion from the intestinal glands is 
greatly augmented, as well as the vascularity and peristalsis of the 
intestines. The biliary flow is but little affected. 

Purgation is produced by jalap in three or four hours, the 
evacuations being profuse and watery and attended with griping 
pain. 

Jalap — or, preferably, the compound jalap powder — is a reliable 
hydragogue cathartic for the removal of dropsical effusions, being 
especially appropriate for nephritic patients. 

Small doses of jalap are serviceable in constipation due to de- 
ficient intestinal secretion. 

The drug is frequently associated with anthelmintic medicines 
as a vermifuge. 

Scammonium— Scammonii— Scammony. U. S. P. 

Definition. — A gum resin obtained by incising the living root of Convolvulus 
Scammonia L. Scammony is an herbaceous, twining perennial, growing in Syria, Asia 
Minor, and Greece. 

Description and Properties. — Occurring in irregular angular pieces or cir- 
cular cakes, greenish gray or blackish, internally porous, and breaking with an angular 
fracture, of a resinous luster ; odor peculiar, somewhat cheese-like ; taste slightly 
acrid ; powder gray or greenish gray. 

It contains a glycoside, jalapin, which is the active principle, besides gum, 
starch, etc. 

Dose. — I— 15 grains (0.06-1.0 Gm. ) [4 grains (0.25 Gm.), U. S. P.]. 

Official Preparation. 

Resina Scammonii — Resinae Scammonii — Resin of Scammony. — Descrip- 
tion and Properties. — Yellowish-brown or brownish-yellow masses or fragments, break- 
ing with a glossy, resinous fracture, translucent at the edges, or a yellowish- white or 
grayish- white powder, having a faint, peculiar odor, and a slight, peculiar taste. Sol- 
uble in alcohol in all proportions. 

Dose. — 1-8 grains (0.06-0.5 Gm.) [3 grains (0.20 Gm. ), U. S. P.]. 

Physiological Action and Therapeutics. — The action of scam- 
mony is identical with that of jalap, save that it stimulates the 
muscular coat of the intestines more, producing more irritation 
and griping than jalap, though not increasing secretion so much 
as the latter drug. 

The therapeutics are the same as for jalap. 

The drug may be given in powder, emulsion, or in milk, but is 
less inactive in pilular form. 

Podophyllum— Podophylli— Podophyllum. V. S. JP. 

(May Apple.) 

Origin. — The dried rhizome and roots of Podophyllum peltatum L., an herba- 
ceous perennial growing in rich woodlands in Canada and the United States. 

Description and Properties. — Of horizontal growth, consisting of joints 
about 2 inches (5 Cm.) long, flattish cylindrical, about % inch (6 Mm.) thick, but 
somewhat enlarged at the end, which has a circular scar on the upper side, a tuft of 
about ten nearly simple, fragile roots on the lower side, and is sometimes branched 



538 A TEXT- BOOK OF MATERIA MEDIC A. 

laterally ; smooth or somewhat wrinkled, orange-brown, internally white and mealy, 
with a circle of small wood-bundles ; pith large ; nearly inodorous ; taste sweetish ; 
somewhat bitter and acrid. 

Podophyllum contains a resin, podophyllin, composed principally of two anhy- 
drous isomeric, glycosides podophyllotoxin and picropodophyilin. These represent the 
active principles, although attempts have been made to show that picropodophyilin is 
included in the composition of the former glycoside. Among other constituents of the 
drug are several minor resins and a coloring principle. 

Dose. — 5-20 grains (0.32-1.29 Gm. ) [7^ grains (0.5 Gm. ), U. S. P.]. 

Official Preparations. 

Fluidextractum Podophylli — Fluidextracti Podophylli — Fluidextract of 
Podophyllum. — Dose, 5-20 minims (0.32-1.29 Cc.) [8 minims (0.5 Cc), U. S. P.]. 

Resina Podophylli — Resinae Podophylli — Resin of Podophyllum. — Descrip- 
tion and Properties. — An amorphous powder, varying in color from grayish-white to 
pale greenish-yellow or yellowish-green, turning darker when exposed to heat ; having 
a slight peculiar odor and a peculiar, faintly bitter taste ; permanent in the air ; soluble 
in alcohol in all proportions. 

Dose. — j4~ l grain (0.008-0.06 Gm.) [y^-X grain (0.005 0.015 Gm.), U. S. P.]. 

Pilulae Podophylli, Belladonnae et Capsici — Pilulas Podophylli, Belladonnae 
et Capsici — Pills of Podophyllum, Belladonna and Capsicum. — Each pill con- 
tains % grain (0.016. Gm. = 16 milligrammes) resin of podophyllum, */g grain (0.008 
Gm. = 8 milligrammes) extract of belladonna leaves, and y 2 grain (0.032 Gm. = 30 
milligrammes) capsicum. 

Dose. — Average dose: I pill (U. S. P.). 

Physiological Action and Therapeutics. — The powdered root 
is an irritant to the skin, and when inhaled occasions a decided 
irritation of the eyes and respiratory passages. It is absorbed 
when applied to ulcers and raw surfaces, producing its character- 
istic purgative effects. The drug is a gastro-intestinal irritant, being 
apt to excite nausea, in full doses producing salivation and greatly 
augmenting the intestinal secretions, and especially the bile. Under 
full doses of podophyllum there is marked peristalsis, attended 
with severe griping pains, and in the course of ten or twelve hours 
there is produced a complete evacuation of the bowels, the feces 
being liquid and deeply stained with bile. 

The drug is thought to be an active hepatic stimulant and 
cholagogue, it is a peculiarly appropriate remedy in that condition 
known as torpor of the liver. The constipatioji attending hepatic 
cirrhosis and ca?icer y as well as that from any hepatic disorder, is 
well treated by podophyllum. 

The slowness and completeness of its action, together with its 
property of stimulating the functional activity of the liver, renders 
the drug extremely serviceable in the treatment of habitual consti- 
pation from any cause. 

It should, however, be associated with antispasmodics, such as 
hyoscyamus or belladonna, to overcome its griping. When asso- 
ciated with other purgatives care should be exercised to select 
those only which, like itself, are tardy in their action. 

Owing to the susceptibility of certain persons to the drug, 
the dosage should be small at first and gradually increased as 
necessary. 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 539 
SALINE CATHARTICS, 

Liquor Magnesii Citratis— Liquoris Magnesii Citratis 
—Solution of Magnesium Citrate. XI. S. P. 

Formula : Dissolve magnesium carbonate, 15, in a solution of citric acid, 33 ; add 
syrup of citric acid, 60; then crystals of potassium bicarbonate, 2.5. Cork the bottle 
and wire immediately. The product effervesces when uncorked. 

Dose.— 2-8 fluidounces (60.0-237.0 Cc.) [12 fluidounces (360 Cc), U. S. P.], 

Magnesii Sulphas— Magnesii Sulphatis— Magne- 
sium Sulphate. U. S. -P. 

(Epsom Salt.) 

Origin. — Obtained by the action of sulphuric acid upon native magnesium car- 
bonate, treated with water, filtered, and the filtrate evaporated to crystallization. 

Description and Properties. — Small, colorless, rhombic prisms or acicular 
crystals, without odor, and having a cooling, saline, and bitter taste ; slowly efflores- 
cent in dry air. Soluble in 1.5 parts of water ; insoluble in alcohol. 

Dose.— l X-i ounce (8.0-32.0 Gm.) [^ ounce (16 Gm.), U. S. P.]. 

Antagonists and Incompatibles. — Magnesium sulphate is in- 
compatible with alkaline carbonates, phosphoric acid, phosphates, 
lead acetate, silver nitrate, and lime water. 

Synergists. — Saline purgatives. 

Magnesii Sulphas Effervescens — Magnesii Sul- 
phatis Effervescens— Effervescent Magnesium 
Sulphate. U. S. P. 

Magnesium sulphate, 500; sodium bicarbonate, 403; tartaric acid, 21 1 ; citric 
acid, 136. 

This may take the place of magnesii citras effervescens (U. S. P., 1890), which 
has been dropped. 

Dose. — Average dose: 240 grains (16 Gm. ), U. S. P. 

Potassii Sulphas— Potassii Sulphatis— Potassium 
Sulphate. TJ. S. JP. 

Origin. — Prepared by adding potassium carbonate to acid potassium sulphate. 

Description and Properties. — Hard, colorless, transparent, six-sided, 
rhombic prisms terminated by pyramids, or in white powder; odorless, and having a 
somewhat bitter, saline taste. Permanent in the air. Soluble in about 9 parts of 
water, insoluble in alcohol. 

Dose. — }4~4- drams (2.0-16.0 Gm.) [30 grains (2 Gm.), U. S. P.]. 

Potassii et Sodii Tartras— Potassii et Sodii Tartratis 
—Potassium and Sodium Tartrate. TT. S. I*. 

(Rochelle Salt.) 

Origin. — Prepared by adding acid potassium tartrate to a hot solution of sodium 
carbonate. 

Description and Properties. — Colorless, transparent rhombic prisms, or a 
white powder, odorless, and having a cooling, saline taste. The crystals slightly effer- 
vesce in dry air. Soluble in 1.4 parts of water, almost insoluble in alcohol. 

Dose. — 30 grains to 1 ounce (2.0-32.0 Gm. ) [120 grains (8 Gm. ), U. S. P.]. 



540 A TEXT-BOOK OF MATERIA MEDICA. 

Official Preparation. 

Pulvis Effervescens Compositus — Pulveris Effervescentis Compositi — 
Compound Effervescing Powder (Seidlitz Powder). — Each powder has of 
Rochelle salt, 93; of sodium bicarbonate, 31, mixed in a blue paper; and of tartaric 
acid, 27 grains, in a white paper. 

Dose. — One or two of each dissolved separately in separate quantities of water, the 
solutions poured together and drunk while effervescing. 

Sodii Phosphas— Sodii Phosphatis— Sodium Phos- 
phate, v. s. r. 

(Sodium Orthophosphate.) 

Origin. — Prepared by digesting bone ash with sulphuric acid. The solution is 
filtered, and to it is added sodium carbonate, and the filtrate evaporated to crystalliza- 
tion. 

Description and Properties. — Large, colorless, monoclinic prisms, odorless, 
and having a cooling, saline taste. The crystals effloresce in the air, and gradually lose 
5 molecules of water of crystallization. Soluble in 5.5 parts of water ; insoluble in 
alcohol. Sodium phosphate should be kept in well-stoppered bottles, in a cool place. 

Dose. — 5 grains to 1 ounce (0.32-32.0 Gm. ) [30 grains (2 Gm.), U. S. P.]. 

Official Preparations. 

Sodii Phosphas Exsiccatus, 15 grains (1 Gm.). 

Sodii Pyrophosphas, 30 grains (2 Gm.). 

Sodii Phosphas Effervescens, 2 drams (8 Gm. ). 

Liquor Sodii Phosphatis Compositus, 2 drams (8 Cc), are all useful. 

Sodii Sulphas— Sodii Sulphatis— Sodium Sulphate. 

V. S. JP. 

(Glauber's Salt.) 

Origin. — The residue left in the manufacture of hydrochloric acid from salt is 
neutralized with sodium carbonate. 

Description and Properties. — Large, colorless, transparent, monoclinic 
prisms or granular crystals ; odorless, and having a bitter, saline taste. The salt 
effloresces rapidly in the air, and finally loses all its water of crystallization. Soluble 
in 2.8 parts of water and in glycerin ; insoluble in alcohol. 

Dose. — 1-8 drams (4.0-32.0 Gm.) [15 grains (l Gm. ), U. S. P.]. 

Physiological Action and Therapeutics of the Salines. — These 
preparations greatly augment the amount of fluid in the intestinal 
canal. This increase of fluid is not a secretion, but a result of the 
high osmotic equivalent of the salts, which tends to draw the body- 
fluids into the intestines, while hindering to a certain extent absorp- 
tion of fluid from the intestines. The purgative influence is really 
due to the mechanical action of the fluid in the intestines. 

Save the sulphate and phosphate of sodium, the salines have 
little effect upon the biliary secretions. 

The sodium salts are more efficient than the potassium salts as 
purgatives, owing to their higher osmotic equivalents. 

Purgation by the salines is painless, and occurs usually in from 
two to three hours after administration, there being ordinarily two 
or three watery evacuations. 



DRUGS ACTING ON G ASTRO-INTESTINAL ORGANS. 541 

In cases of habitual constipation, particularly that associated 
with the gouty diathesis, there are no better purgatives than the salts 
of sodium or mineral waters containing them, such as Carlsbad, 
Marienbad, Hunyadi Janos, Apenta, etc. 

For children there is no better purgative than sodium phos- 
phate, especially where the stools show a deficiency of bile. In 
duodenal catarrh excellent results are obtained by this drug ; also 
in chronic rheumatism, and to retard the formation of biliary calculi. 

Concentrated saline purgatives are efficient remedies for the 
removal of dropsical and pleuritic effusions. 

Magnesium sulphate, combined with dilute sulphuric acid, is 
the most efficient treatment in cases of chronic lead-poisoning. 

Rochelle salt and Seidlitz powder are pleasant and useful 
purgatives in cases of biliousness, migraine, etc. Solution of mag- 
nesium citrate is used for the same purpose, but, while very 
palatable and acceptable to the stomach, is not always reliable, 
besides being apt to occasion slight griping. 

Administration. — The salines should be taken dissolved in 
as concentrated a solution as possible, and ordinarily should be 
administered in the morning, when the stomach is empty. 



ANTHELMINTICS. 

Anthelmintics are remedies which kill or expel intestinal worms. 
Those drugs which kill the parasites are called vermicides, and 
those which simply promote their expulsion are called vermifuges} 
There is little real distinction in these terms. 

The vermicides are : 

Aspidium, Kamala, 

Chenopodium, Oleum Terebinthinae,* 

Cusso, Pepo, 

Granatum, Santonica. 

The vermifuges are : 

Calomel,* Spigelia. 

Hydragogue Purgatives,* 

Anthelmintics are here divided according to the kind of intesti- 
nal parasite against which they are employed. 

The Oxyuris vermicularis is a small worm, often called seat- 
worm or threadworm, that infests the large intestine and rectum. 
The Ascaris lumbricoides is the common roundworm, found chiefly 
in the small intestine. 

The TcEnice are the tapeworms. 

Anchylostoma, or Uncinaria, is the name given to a genus of 
important hook worms. 

1 Drugs marked with an asterisk (*) are considered elsewhere. 



542 A TEXT-BOOK OF MA TERIA MEDICA. 

Remedies employed against the Oxyuris vermicularis : l 
A weak solution of Carbolic Acid,* Lime Water,* 
Infusion of Quassia,* Calomel,* 

Decoction of Aloes,* Oleum Terebinthinae.* 

Remedies employed against the Ascaris lumbricoides : 
Chenopodium, Calomel,* 

Santonica, Hydragogue Purgatives,* 

Spigelia, Oleum Terebinthinae.* 

Remedies employed against the Tcenia Solium and other varieties 
of Tcenia : 

Aspidium, Kamala, 

Cusso, Pepo, 

Granatum, Oleum Terebinthinae.* 

Remedies for Anchylostoma are as for Ascaris. Thymol is con- 
sidered a specific. 

Oleum Chenopodii— Olei Chenopodii— Oleum 
Chenopodii. IT. S. .P. 

(Oil of American Wormseed.) 

Origin. — A volatile oil distilled from chenopodium. 

Description and Properties. — A thin, colorless or yellowish liquid, having 
a peculiar penetrating, somewhat camphoraceous odor, and a pungent and bitterish 
taste. 

Dose. — 2-10 minims (0.12-0.6 Cc.) [3 minims (0.2 Cc), U. S. P.]. 

Physiological Action and Therapeutics. — Both the powdered 
seed and the oil are efficient anthelmintics, particularly useful to 
expel roundworms {Ascarides lumbricoides) from children. The 
drug should invariably be followed by a brisk cathartic. The 
powder may be given suspended in molasses, or the oil may be 
given dropped upon loaf-sugar, or in the form of an emulsion, or 
enclosed in capsules. 

Santonica— Santonicae— Santonica. U. S. J*. 

(Levant Wormseed.) 

Origin. — The dried unexpanded flower-heads of Artemisia pauciflora Weber, a 
plant growing in Asia and exclusively collected iu Northern Turkestan. 

Description and Properties. — From -fc-yi inch (2-3 Mm.) long, oblong- 
ovoid, obtuse, smooth, somewhat glossy, grayish-green, after exposure to light brown- 
ish-green, consisting of an involucre of about twelve to eighteen closely imbricated, 
glandular scales with a broad midrib, enclosing four or five rudimentary florets; odor 
strong, peculiar, somewhat camphoraceous ; taste aromatic and bitter. The drug con- 
tains about 2 per cent, of a neutral principle, santonin, to which its anthelmintic prop- 
erties are due. It also contains about I per cent, of an unimportant volatile oil. 

Dose. — 10-60 grains (0.6-4.0 Gm. ). 

1 Drugs marked with an asterisk ('*) are considered elsewhere. 



DRUGS ACTING ON G ASTRO-INTESTINAL ORGANS. 543 

Santoninum— Santonini— Santonin. JJ. S. -P. 

Definition. — The inner anhydride or lactone of santonic acid, obtained from 
Santonica. 

Description and Properties. — Colorless, shining, flattened, prismatic crys- 
tals, odorless, and nearly tasteless when first put into the mouth, but afterward develop- 
ing a bitter taste ; not altered by exposure to air, but turning yellow on exposure to 
light. Nearly insoluble in cold water ; soluble in 34 parts of alcohol. Santonin 
should be kept in dark, amber-colored vials, and should not be exposed to light. 

Dose. — %-i grain (0.016-0.06 Gm.) for a child; 1-5 grains (0.06-0.32 Gm.) 
for an adult [1 grain (0.065 Gm.), U. S. P.]. 

Official Preparation. 

Trochisci Santonini — Trochiscos (ace.) Santonini — Troches of Santonin. 

Each troche contains ^ grain (0.03 Gm.). 
Dose. — 2 (child) to 10 (adult) troches. 

Physiological Action and Therapeutics. — In full or large 
doses santonin may excite nausea or vomiting, with abdominal 
pain, diarrhea, eructations, borborygmi, and great thirst. It readily 
enters the blood, where it exists as sodium santoninate. Large 
doses may cause giddiness, headache, hallucinations of smell and 
taste, tremors, and a species of depression, the combination of 
symptoms forming what is called santonin intoxication. 

The drug is chiefly eliminated through the kidneys, small 
amounts of santonin even imparting to the urine a distinct yellow 
color if the urine is acid, and a decided purplish or even red color 
if the urine is alkaline. Under certain circumstances when the 
urine is decidedly alkaline, as in cases of cystitis, the administra- 
tion of santonin may produce so marked a discoloration of the 
urine as to suggest hematuria. 

Probably the most remarkable phenomenon attending the inges- 
tion of medicinal doses of santonin is that of xanthopsia or yellow 
vision, which may continue for several hours. According to Rose, 
" there occasionally appears before the peculiar yellow sight, after 
large doses of santonin, a violet color of the field of vision : the 
intensity of this color is in proportion to the darkness of the objects 
looked at. All light objects, such as windows, paper, etc., appear 
actually yellow. Red and blue appear often in their complementary 
colors, orange and green, so that carmine-red appears pale, madder- 
red a bronze color, and the sky and blue objects green. This, 
however, is not always the case, and it has been noticed after the 
employment of santonin that red appears violet or light, and dark 
objects appear orange to one person, and to another green." — 
(Quoted from Lewin.) This peculiar effect of santonin is due, 
according to Rose, to a nervous change in the retina or in the brain. 

Affections of the skin — e. g. y urticaria — have occasionally fol- 
lowed the administration of santonin. Decidedly poisonous effects 
have sometimes been produced by comparatively small amounts of 
the drug. The symptoms of a fatal case from over-dose of santonin 
were convulsions accompanied by unconsciousness, twitching of the 



544 A TEXT-BOOK OF MA TERIA MEDICA. 

eyeballs, dilated pupils, cold sweat, weak pulse, feeble respiration, 
and, after some hours, sudden death. 

In case of poisoning by santonin the remedial measures are in- 
ternal and external stimulants, eliminants, and artificial respiration. 
Santonin is certainly a most efficient remedy against the ascaris, 
and to a less extent it is of use against the oxyuris. It has no 
effect on the tcenia. 

The drug should be given on an empty stomach, preferably at 
night, either alone or associated with calomel, and followed in two 
or three hours by castor oil or other brisk cathartic. It may be 
administered in the form of a powder mixed with sugar or jelly, or 
in pills or capsules. Troches of santonin are much used and are 
very efficient. Care should be taken that they are fresh and that 
they should not be permitted to remain a great length of time in 
the intestine. 

Spigelia— Spigeliae— Spigelia. U. S. -P. 

(PlNKROOT.) 

Origin. — The dried rhizome and roots of Spigelia marilandica L., a plant growing 
in rich shady woods, chiefly in the southern part of the United States, but found as far 
northward as Pennsylvania and Wisconsin. 

Description and Properties. — Of horizontal growth, about 2 inches (5 
Cm. ) or more long, about \ inch (3 Mm.) thick, dark purplish-brown, bent, somewhat 
branched on the upper side, with cup-shaped scars ; on the lower side with numerous 
thin, brittle, light-colored roots about 4 inches (10 Cm.) long; the rhizome internally 
with a whitish wood and a pith which is usually dark-colored or decayed ; odor some- 
what aromatic ; taste sweetish, bitter, and pungent. 

It contains a volatile alkaloid, spigeline, which is thought to be the active principle. 

Dose. — X -2 drams (1.0-8.0 Gm.) [60 grains (4 gm.), U. S. P.]. 

Official Preparation. 

Fluidextractum Spigeliae — Fluidextracti Spigeliae — Fluidextract of Spigelia. 

— Dose, ]i-2. fluidrams (1.0-8.0 Cc.) [1 dram (4 Cc), U. S. P.]. 

Physiological Action and Therapeutics. — Spigelia is a pow- 
erful anthelmintic, being a decided vermifuge against the Ascaris 
lumbricoides. When given alone and in full doses it may produce 
symptoms of narcotic poisoning. The symptoms are those of de- 
pression of the respiration with convulsive seizures and occasionally 
temporary blindness. This may be obviated by associating it with 
cathartics and aromatics. 

The drug may be administered in the form of a tea, associated 
with senna, fennel, or other aromatics. The fluidextract is a reli- 
able preparation. 

Aspidium— Aspidii— Aspidium. U. S. JP. 

(Male Fern.) 

Origin. — Hie dried rhizome of Dryopteris Filix mas Schott, or of Dryopteris 
marginalis (L.) Gray, plants indigenous in North America, a portion of South America, 
Asia, Europe, and some parts of Africa. 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 545 

Description and Properties.— From 3 to 6 inches (7-15 Cm.) long, y 2 to 
I inch (12-25 Mm.) thick, and, together with the closely imbricated, dark-brown, 
roundish, and slightly curved stipe-remnants, 2 to 3 inches (50-75 Mm.) in diameter; 
densely covered with brown, glossy, transparent, and soft, chaffy scales ; internally pale 
green, rather spongy ; vascular bundles about ten {Dryopteris Filix mas) or six [Dryop- 
teris marginalis) in number, arranged in an interrupted circle ; odor slight, but disa- 
greeable; taste sweetish, acrid, somewhat bitter, astringent, and nauseous. Aspidium 
contains filicic acid, aspidin, aspidinin ( phloroglucin allies), which are thought to rep- 
resent the active principles, fixed oil, a trace of volatile oil, and chlorophyl. 

Dose. — yi-2 drachms (2.0-8.0 Gm.). 

Official Preparation. 

Oleoresina Aspidii— Oleoresinse Aspidii — Oleoresin of Aspidium. — Dose, 
}(-\ fiuidram (1.0-4.0 Cc.) [30 grains (2 Gm.), U. S. P.]. 

Note. — Oleoresin of aspidium usually deposits, on standing, a granular crystalline 
substance. This should be thoroughly mixed with the liquid portion before use. The 
oleoresin should be kept in well-stoppered bottles. 

Physiological Action and Therapeutics. — Aspidium is the 
most reliable tceniacide known to materia medica. Though it is 
employed against both the armed and unarmed varieties of tape- 
worm, it is nevertheless against the latter that it is specially effect- 
ive. In the cases of armed taeniae special precautions must be 
taken to ensure success. 

The drug possesses tonic and astringent properties, and if taken 
in very large doses may occasion nausea, vomiting, diarrhea, and 
gastric and abdominal pains. 

Several fatal cases of poisoning have occurred by reason of un- 
looked-for causes permitting absorption. The symptoms have 
been long in developing, and consist of pain, nausea, vomiting, 
occasionally icterus, confusion, clouding of consciousness, blindness, 
great muscular depression, trismus, mydriasis, collapse, coma, and 
death after a few days. 

When given for the expulsion of tapeworm the bowels should 
first be emptied by a castor-oil purge, and then the oleoresin be 
administered in gelatin capsules or in emulsion. 

Blindness has been a permanent effect on recovery from poison- 
ing in some cases. 120 grains (8 Gm.) have been fatal for a child and 
43 Gm. of root for an adult. 

Previous to the exhibition of the anthelmintic the patient should 
live on exceedingly spare diet for at least twenty-four hours, and 
the medicine then be given in the morning fasting. A few hours 
later an active purge of about 1 ounce (30.0 Cc.) of castor oil or 
calomel and jalap should be given to expel the dead worm, which 
should be carefully examined for the head. If the head does not 
pass, the treatment should be repeated the following day or soon 
after. 

Cusso— Cusso— Kousso. U. S. J*. 

(Brayera.) 

Definition. — The dried panicles of the pistillate flowers of Hagenia abyssinica 
(Bruce) Gmelin, a handsome tree 40 to 50 feet (12-18 M.) high, indigenous on the 
table-land and in the mountainous districts of Abyssinia. 

35 



546 A TEXT -BOOK OF MA TERIA MEDICA. 

Description and Properties. — In bundles, rolls, or compressed clusters 
consisting of panicles about io inches (25.0 Cm.) long, with a sheathing bract at the 
base of each branch ; the two roundish bracts at the base of each flower and the four or 
five obovate outer sepals are of a reddish color, membranous and veiny; calyx top- 
shaped, hairy, enclosing two carpels or nutlets ; odor slight, fragrant, and tea-like ; taste 
bitter, acrid, and nauseous. 

It contains an active principle, kosotoxin, a tasteless and an acid resin, and about 
24 per cent, of tannin. 

Dose. — 1-4 drams (4.0-16.0 Gm.) [240 grains (16 Gm.), U. S. P.]. 

Physiological Action and Therapeutics. — The action of kousso 
upon the digestive tract, under large doses, is similar to the action 
of aspidium. It is a reliable anthelmintic for all species of tape- 
worm. The fluidextract should be given in the form of an emul- 
sion, the patient having previously fasted, and the exhibition of the 
drug followed in a few hours by a large dose of castor oil. Nausea, 
vomiting, diarrhea, and collapse may develop after large doses. 



Granatum— Granati— Pomegranate. U. S. _P. 

Origin. — The bark of the stem and root of Punica Granatum L., a shrub or small 
tree about 20 feet (6 M.j high, indigenous in Southwestern Asia from Northern India 
to Palestine. 

Description and Properties. — In thin quills or fragments from 2 to 4 inches 
(5-10 Cm.) long and from ^ to }/% inch (1-3 Mm.) thick; outer surface yellowish 
gray, somewhat warty or longitudinally and reticulately ridged ; the stem-bark often 
partly covered with blackish lichens ; the thicker pieces of the root-bark more or less 
scaly externally ; inner surface smooth, finely striate, grayish yellow ; fracture short, 
granular, greenish yellow, indistinctly radiate ; inodorous ; taste astringent, very slightly 
bitter. 

It contains as its active constituent a liquid alkaloid, pelletierine, with its three 
allied alkaloids, ?nethylpelletierine, pseudopelletierine, and isopelletierme, besides mannite 
and punico-tannic acid. 

Dose. — }&-I}6, drams (2.0-6.0 Gm.) [30 grains (2 Gm.), U. S. P.]. 

Unofficial Preparations. 

Pelletierinae Tannas — Pelletierinae Tannatis — Pelletierine TannatefU. S.P.). 
— Definition. — A mixture in varying proportions of the tannates of four alkaloids 
(punicine, isopunicine, methylpunicine, and pseudopunicine) obtained from Punica 
granatum (pomegranate). 

Also known as punicinum tannicum. The alkaloids are also known as pelletierine, 
isopelletierine, etc. 

Description. — A yellowish-white, odorless, amorphous powder, having an astringent 
taste, and a weak acid reaction. Soluble in water (1 : 235), alcohol (I : 12.6), and in 
warm dilute acids. 

Dose. — Average dose: 4 grains (0.250 Gm. — 250 Mg.) , U. S. P.. 

The pelletierinesof commerce seem to vary greatly ; some are ten times as poisonous 
as others. While the U. S. Pharmacopoeia names, as the average dose of the tannate, 
4 grains (0.25 Gm.), some writers recommend 10-20 grains (0.75-1.5 Gm. ). Very 
unpleasant effects are said to have resulted from 20-7.5 grains (0.4-0.5 Gm. ). 

Fluidextractum Granati — Fluidextracti Granati — Fluidextract of Pome- 
granate ( L*. S. P.). — Definition. — Hitherto only the bark of the stem and root of Gra- 
natum (pomegranate) has been official ; it was often administered in the form of a 
decoction (official in the Br. P.), but this was very unpleasant to take, owing to the 
large amount of tannic acid present. A mixture of the tannates of the most important 
active constituents (four alkaloids) of granatum has also been introduced under the 
name Pelteticrina: Tannas (q. v.). 

Dose. — Average dose: 30 minims (2 Cc. ), U. S. P. 



DRUGS ACTING ON GASTRO-INTESTINAL ORGANS. 547 

Physiological Action and Therapeutics. — Locally pomegran- 
ate is astringent. In large doses it excites vomiting, acts as a 
purgative, paralyzes the motor nerves, but does not affect sensa- 
tion, and dilates the capillaries. 

Poisonous symptoms usually begin with severe headache, giddi- 
ness, chilly sensations, and rise in temperature. There is mydriasis 
and collapse, with nausea and vomiting. Blindness has been known 
to occur and to persist for some time. 

Pomegranate and its alkaloid, pelletierine, are efficient anthel- 
mintics for tapeworm. 

Like other anthelmintics, the drug should be given on an empty 
stomach, and if the bowels are not freely moved by the remedy, an 
active cathartic should follow its administration. 

A decoction of the bark may be used, but, owing to the diffi- 
culty in obtaining the fresh drug, which alone possesses anthel- 
mintic properties, the tannate of pelletierine, which is always 
reliable, is usually administered. 

Pepo— Peponis— Pumpkin Seed. U. S. J*. 

Origin. — The ripe seed of Cucurbit a pepo L., the common pumpkin, indigenous 
in tropical Asia and America, and cultivated throughout the temperate zones. 

Description and Properties. — About % inch (2 Cm.) long, broadly-ovate, 
flat, white or whitish, nearly smooth, with a shallow groove parallel to the edge ; con- 
taining a short, conical radicle and two flat cotyledons ; inodorous ; taste bland and 
oily. It contains an acrid resin, supposed to be the active principle, and from 30 to 
35 per cent, of a thick red fixed oil. 

Dose. — 1-3 ounces (32.0-94.0 Gm.) [1 ounce (30 Gm. ), U. S. P.]. 

Physiological Action and Therapeutics. — Pumpkin seed ranks 
next to aspidium in the minds of some therapeutists as a remedy 
for the destruction of tapeworm, and has the advantage of being 
free from any disagreeable taste or unpleasant action. For admin- 
istration the fresh pumpkin seeds should be beaten into a paste 
with powdered sugar and diluted with milk or water to about 1 pint 
(500 Cc). Previous to its administration the patient should fast 
for twenty-four hours, when the bowels should be flushed out with 
a large saline purgative. A portion of the emulsion of pumpkin 
seed is then to be taken, preferably in the morning, and the balance 
taken in two doses at intervals of about two hours, the patient 
meanwhile remaining in bed to prevent, as far as possible, disturb- 
ance of the stomach. 



DRUGS ACTING PARTICULARLY ON THE UTERUS. 



EMMENAGOGUES AND ECBOLICS. 

Emmenagogues are remedies which restore or increase the men- 
strual flow. They are divided, according to their action, into two 
classes. Those which act upon the uterine muscle or mucous 
membrane are said to be direct ; those which influence the uterus 
by affecting the general health of the body, or by altering the 
blood-supply of the parts, or by influencing the nervous system, 
are said to be indirect. 

The principal Direct Emmenagogues are — 

Ergot, Borax, 

Digitalis, Rue, 

Savine, Hydrastis, 

Quinine, Caulophyllum, 

Asafetida, Tansy, 

Myrrh, Apiol, 

Guaiac, Hedeoma. 
Cantharides, 



Leeches 



The Indirect Emmenagogues are — 

Iron and the Hematics, Cinnamon, 

Cod-liver Oil, Aloes. 

Strychnine, 

( Hot foot-bath. 
Baths < Hot hip-bath. 

[ Mustard bath. 

f To genitals. 

\ To thighs. 

( Baths. 
Mustard < Poultices to thighs. 

( Stupes. 

Ecbolics or oxytocics are remedies which act directly upon the 
uterine muscular fibers, inducing uterine contraction, and are chiefly 
used during or immediately after parturition to produce or increase 
uterine action. They are, therefore, contraindicated before parturi- 
tion, lest they induce abortion, although they are often used crimi- 
nally for this purpose. 

The exact manner in which ecbolics act is unknown, but it is 

548 



DRUGS ACTING PARTICULARLY ON THE UTERUS. 549 

supposed that they act directly by stimulating the uterine center 
in the cord, or reflexly through uterine congestion. 

In small doses many of the ecbolics are emmenagogue, while 
many of the direct emmenagogues are ecbolic. 

The only justifiable uses for ecbolics are in parturition, with 
uterine inertia and unobstructed and well-dilated maternal parts, 
when it is desired to hasten the delivery of the child, or, second, 
to induce firm contraction of the uterus, and thus prevent or check 
uterine hemorrhage after the birth of the child. 

The principal Ecbolics are — 

Ergot, Oil of rue, 

Ustilago, Borax, 

Hydrastis, Pilocarpine, 

Berberis, Potassium permanganate, 

Savine, Strong purgatives, 

Quinine, Pennyroyal. 

Cotton-root Bark, 

Drugs which have not been considered elsewhere in the present 
work will be described here : 

Sabina— Sabinae— Savine. U. S. J\ 

Origin. — The tops of Juniperus Sabina L., a small evergreen procumbent or 
erect shrub, distributed throughout the greater portion of Europe, Siberia, Canada, 
and the Northern United States. 

Description and Properties. — Short, thin, subquadrangular branchlets ; 
leaves rather dark green, in four rows, opposite, scale-like, ovate-lanceolate, more or 
less acute, appressed, imbricated, on the back with a shallow groove containing an 
oblong or roundish gland ; odor peculiar, terebinthinate ; taste nauseous, resinous, and 
bitter. 

It contains 2 per cent, of a volatile oil, tannin, resin, gum, etc. 

Dose. — 5—15 grains (0.3-1.0 Gm.) [7 \ grains (0.5 Gm.), U. S. P.]. 

Official Preparation. 

Fluidextractum Sabinae — Fluidextracti Sabinae — Fluidextract of Savine. 
Dose, 5-15 minims (0.3-1.0 Cc.) [5 minims (3 Cc), U. S. P.]. 

Oleum Sabinae— Olei Sabinae— Oil of Savine. 

U. S. JP. 

Origin. — A volatile oil distilled from the fresh tops of savine. 

Description and Properties. — A colorless or yellowish liquid having a 
pecular terebinthinate odor and a pungent, bitterish, and camphoraceous taste. It 
becomes darker and thicker by age and exposure to the air. Soluble in an equal 
volume of alcohol. 

Dose. — 1-5 minims (0.06-0.3 Cc. ) [1 minim (0.05 Gm.), U. S. P.]. 

Physiological Action and Therapeutics. — The action of savine 
depends on the presence of the volatile oil, and this oil differs in 
its local external effect from the oil of turpentine merely in that 
the oil of savine is more active. It occasions much irritation, vesi- 
cation, and even pustulation when applied to the skin. Taken 



550 A TEXT-BOOK OF MATERIA MEDICA. 

internally in small closes, it produces a sensation of heat in the 
epigastrium, with flatulence and frequently nausea. Toxic doses 
excite violent gastro-enteritis. 

The drug stimulates the heart's action, and later, under full me- 
dicinal doses, depresses it. It is rapidly absorbed, and is excreted 
by various channels, increasing the urinary and bronchial excre- 
tions. These excretions, as well as the sweat and breath, smell 
strongly of the drug. 

Savine is a decided irritant to the uterus and ovaries, inducing 
marked hyperemia of those organs, and promoting contractions of 
the pregnant uterus. 

Toxic doses produce symptoms similar to those occasioned by 
oil of turpentine — violent gastro-enteritis, suppressed or bloody 
urine, great depression, etc. The treatment in poisoning by oil of 
savine would be full doses of Epsom salt, demulcents, anodynes, 
and stimulants if necessary. 

Savine in the form of an ointment is used as a stimulant appli- 
cation to keep up the discharge from blisters. An alcoholic solu- 
tion of oil of savine, 5-30 minims (0.3-1.8 Cc.) to 1 ounce (30.0 
Cc), is used in alopecia pityroides. 

Oil of savine is a very efficient remedy in amenorrhea, and is 
also of benefit in certain cases of menorrhagia due to an enlarged 
and passively congested uterus. The hemorrhage following abor- 
tion is usually well controlled by this remedy. 

The powder or fluidextract may be given, but the oil is the 
most effective preparation, and may be prescribed in capsules, pills, 
or emulsion. It should be given cautiously. 

Ruta— Rutae— Rue. {Non-official.) 

Origin. — The leaves of Ruta graveolens L. , an herbaceous or suffruticose peren- 
nial 2 or 3 feet (60 or 90 Cm.) high, indigenous in Southern Europe. 

Description and Properties. — The leaves are ternate, the leaflets being 
obovate-oblong, yellowish-green, thickly dotted with minute, transparent oil-vesicles. 
They have a peculiar, strongly balsamic odor, and possess an aromatic, bitter, and 
acrid taste. 

The principal constituent of rue is a volatile oil. 

Dose. — 5-20 grains (0.3-1.3 Gm.). 

Oleum Rutae— Olei Rutae— Oil of Rue. 
(Non-official,) 

•Origin. — A volatile oil distilled from R7ita graveolens L. 

Description and Properties. — A colorless or greenish-yellow liquid with 
"(he peculiar odor of the plant, and a pungent, somewhat acrid, bitterish taste. Sol- 
uble in an equal weight of alcohol. 

Dose. — 2-5 minims (0.13-0.3 Cc). 

Physiological Action and Therapeutics. — The action of oil 
of rue is analogous to that of oil of savine, though less powerful. 
It is used for the same purposes also, and has occasionally been 
employed in hysteria. 

The oil should be administered in capsules. 



DRUGS ACTING PARTICULARLY ON THE UTERUS. 55 1 

Tanacetum— Tanaceti— Tansy. (Non-official.) 

Origin. — The leaves and tops of Tanacetum vulgare L., a perennial herb indig- 
enous in Europe and Central Asia, and naturalized in many parts of North America. 

Definition and Properties. — Leaves about 6 inches (15.24 Cm.) long, 
bipinnatifid, the segments oblong, obtuse, serrate, or incised, smooth, dark green, and 
glandular ; flower-heads corymbose, with an imbricated involucre, a convex, naked 
receptacle, and numerous yellow tubular florets ; odor strongly aromatic ; taste pungent 
and bitter. 

It contains a volatile oil and a bitter principle, tenacetin, besides tannin, resin, etc. 

Dose. — 15-60 grains ( 1.0-4.0 Gm.), in infusion. 

Physiological Action and Therapeutics. — In moderate doses 
tansy acts as an aromatic bitter. Excessive amounts produce all 
the symptoms of an irritant narcotic — vomiting, purging, severe 
abdominal pain, loss of consciousness, convulsions, and great car- 
diac and respiratory weakness, death usually resulting from paral- 
ysis of respiration. 

The drug is regarded as an efficient remedy in amenorrhea, and 
is extensively employed in domestic practice in hysteria and colic, 
and topically for braises, sprains, muscular pains, etc. 

It is used in the rural districts to promote or restore menstrua- 
tion, and occasionally is employed with criminal intent as an abor- 
tifacient, but usually with negative results. 

The drug may be given in the form of an infusion, 1 ounce to 
1 pint (32.0 Gm.-473.17 Cc), of which I or 2 fluidounces (30.0 
or 60.0 Cc.) may be taken at a dose. 

The oil of tansy is occasionally prescribed in doses of 1-5 min- 
ims (0.06-0.3 Cc). 

Petroselinum— Petroselini— Parsley. {Non-official.) 

Origin.- — The root of Petroselinum sativum (Hoffmann), Apium Petroselinum 
L., a plant indigenous in Southern Europe, and much cultivated for culinary purposes. 

Description and Properties. — The root is tapering, from 4 to 8 inches 
(10-20 Cm.) long, about J inch (12 Mm.) thick; externally yellowish or light brown ; 
odor aromatic ; taste sweetish and aromatic. 

It contains a volatile oil and apiol, the chief constituent. 

Dose. — 30-60 grains (2.0-4.0 Gm.). 

Unofficial Preparation. 

Apiolum— Apioli — Apiol (Non-official). — Origin. — A camphor obtained from 
the fruit of Petroselinum sativum Hoffmann. 

Description and Properties. — White needles, of a feeble, parsley odor. Insoluble 
in water, but freely soluble in alcohol and in ether. 

Dose. — 10-15 grains (0.6-1.0 Gm.). 

Physiological Action and Therapeutics. — The root is carmin- 
ative, laxative, and diuretic. Apiol is an active emmenagogue. 
Given in excessive doses it occasions severe frontal headache, 
dizziness, and ringing in the ears. It causes a rapid rise of blood- 
pressure, due to increased cardiac action and stimulation of the 
vasomotor centers. 

Apiol, or Chapoteaut's apioline, is usually prescribed, and is 
an efficient remedy in amenorrhea and dysmenorrhea. ' As an em- 



552 A TEXT-BOOK OF MA TERIA MEDICA. 

menagogue in cases of scanty or deficient menstruation apioline 
is very effective. 

Hedeoma— Hedeomae— Hedeoma. U. 8. J\ 

(Pennyroyal.) 

Origin. — The dried leaves and flowering tops of Hedeoma pulegioides (L.) Per- 
soon, an annual herb indigenous in North America. 

Description and Properties. — Leaves opposite, short-petioled, about y^ 
inch (12 Mm.) long, oblong-ovate, obscurely serrate, glandular beneath; branches 
roundish-quadrangular, hairy ; flowers in small, axillary cymules, with a tubular-ovoid, 
bilabiate, and five-toothed calyx, and a pale-blue, spotted, bilabiate corolla, containing 
two sterile and two fertile exserted stamens; odor strong, mint-like ; taste warm and 
pungent. Its virtues depend upon a volatile oil. 

Dose. — 15-60 grains (1.0-4.0 Gm.), in infusion [120 grains (8 Gm.), U. S. P.], 

Official Preparation. 

Oleum Hedeomae— Olei Hedeomas — Oil of Hedeoma (U. S. P.) (Oil of 
Pennyroyal). — Origin. — A volatile oil distilled from the leaves and flowering tops of 
Hedeoma. 

Description and Properties. — A pale-yellowish, limpid liquid, having a character- 
istic, pungent, mint-like odor and taste. It should be kept in well-stoppered bottles, 
in a cool place, protected from light. 

Dose. — 2-10 minims (0.1-0.6 Cc.) [3 minims (0.2 Cc), U. S. P.]. 

Physiological Action and Therapeutics. — Hedeoma is aro- 
matic, stimulant, carminative, and emmenagogue, while the oil is 
rubefacient if rubbed into the skin. 

The herb is given in the form of a hot infusion to bring on 
retarded or suspended menstruation and for the relief of flatulent 
colic y pharyngitis, bronchitis, etc., as well as to dissipate congestions 
of various parts. 

The oil of hedeoma is an active emmenagogue, and is used 
to increase the rubefacient effect of various embrocations. 

Berberis— Berberidis— Barberry. U. S. JP. 

Definition. — The rhizome and roots of Berberis aquifolium and other species 
of berberis. 

Berberis aquifolium is known as Oregon grape root. It contains an alkaloid, ber- 
berine, which is also found in menispermum (a drug dropped from the present revi- 
sion), calumba, hydrastis, and other drugs. 

Dose. — Average dose : 30 grains (2 Gm.), U. S. P. 

Official Preparation. 

Fluidextractum Berberidis — Fluidextracti Berberidis — Fluidextract of Ber- 
beris. — Dose. — Average dose : 30 minims (2 Cc), U. S. P. 

Physiological Action. — Berberis contains an active alkaloid, 
berberinc, an alkaloid widely distributed in the plant kingdom. Its 
relations to hydrastis have given it a slight reputation as a uterine 
stimulant, but it is hardly more than an unnecessary bitter. It has 
no particular physiological action and little practical therapeutic 
worth. 



DRUGS ACTING ON THE RESPIRATORY MUCOUS 

MEMBRANES. 



EXPECTORANTS- 
Expectorants are drugs which stimulate, depress, or modify 
the secretion from the bronchial or laryngeal mucous membranes 
and promote its expulsion. 

There are many drugs not classed as expectorants which, under 
certain conditions, may be used to serve one of these purposes. 
Thus, opium and chloral, by the depressing influence which they 
exert upon the respiratory center and the reflex mechanism, may 
relieve reflex and purposeless cough, or, as is the case with the 
former drug, check excessive secretion or render it more viscid. 

Demulcents, such as gum acacia, flaxseed, elm, etc., and other 
drugs like potassium chlorate, sodium chloride, etc., either lessen 
or excite the tracheal and bronchial cilia, retarding or promo- 
ting expectoration of bronchial mucus. The classification usually 
adopted seems to be the most reasonable — viz., that of dividing 
expectorants into two classes : i. Nauseant or Sedative. 2. Stim- 
ulating. Among the more important Nauseant or Sedative Expec- 
torants * are : 

* Alkalies ; * Ipecacuanha ; 

* Antimony and potassium tar- * Lobelia ; 

trate (tartar emetic) ; * Pilocarpus ; 

* Apomorphine ; * Potassium iodide ; 
Grindelia ; * Quebracho ; 

all of which are considered in detail elsewhere. 

The important Stimulating Expectorants are : 

* Acids ; * Oleum pini pumilionis ; 

* Ammonium carbonate ; * Onion ; 
Ammonium chloride ; * Saccharine substances ; 

* Balsam of Peru ; Sanguinaria ; 

* Balsam of Tolu ; * Senega (saponin) ; 

* Benzoin and benzoic acid; * Sulphur; 

* Copaiba ; * Squill ; 

* Cubeb ; * Tar ; 

* Garlic ; * Terebene ; 
Licorice ; * Terpin hydrate ; 

* Nux vomica * Turpentine ; 

(Strychnine) ; * Volatile oils in general. 

* Oil of Scotch fir (oleum pini 

sylvestris) ; 

1 (Those marked with an asterisk (*) are elsewhere given in detail.) 

553 



554 A TEXT-BOOK OF MATERIA MEDICA. 

As a rule, Sedative Expectorants are permissible only in acute 
stages of bronchitis, when, as in the case in the beginning of all 
catarrhal inflammations, there is complete or partial suspension of 
function, absence of secretion, and much irritation in the bronchi, 
with distressing, harsh, and dry cough. 

In these conditions of the respiratory passages the nauseating 
sedative expectorants serve a useful purpose in lowering arterial 
tension, lessening the blood-supply to the inflamed parts, and 
increasing the secretion of mucus. 

In sufficiently large doses to produce emesis the same expecto- 
rants are frequently employed to expel an accumulation of mucus 
mechanically by the act of vomiting. 

Stimulating expectorants are more serviceable in chronic and 
relaxed conditions of the mucous membrane. They are usually 
employed to diminish or disinfect an abnormally increased secre- 
tion. These remedies generally increase blood-pressure and facili- 
tate expectoration, being eliminated to a great extent by the 
mucous membranes which they stimulate. 

The alkalies are especially useful in lessening the viscidity of 
mucus, rendering it more fluid, less tenacious, and therefore more 
easily expelled. 

It requires considerable skill to combine expectorants so as to 
best suit the various conditions found in practice. The diseases of 
the respiratory passages gradually merge, so that in the treatment 
of them it is often difficult to decide which remedy will be of more 
service, a sedative or a stimulant expectorant. The physician 
should carefully examine each individual case and decide whether 
he wishes to diminish or increase the blood-supply to the respira- 
tory tract ; to stimulate or depress the respirations ; to overcome 
spasm of the bronchial muscles ; to diminish, increase, or disinfect 
the bronchial secretion. 

A thorough knowledge of the patient's condition and of the 
physiological action of the various remedies at command will 
enable the observant practitioner to combine expectorants in such 
manner as to yield ordinarily highly satisfactory results. 



Ammonii Chloridum— Ammonii Chloridi— Ammo- 
nium Chloride. U. S. l y . 

Origin. — Ammonium sulphate is first formed by neutralizing gas liquor with 
sulphuric acid. After crystallization sublime with sodium chloride. 

Description and Properties. — A white, crystalline powder, without odor, 
having a cooling, saline taste, and permanent in the air. Soluble in two parts of 
water ; almost insoluble in alcohol. 

Dose. — 1-30 grains (0.06-2.0 Gm.) [7J grains (0.5 Gin.), U. S. P.]. 

Official Preparation. 

Trochisci Ammonii Chloridi — Trochiscos (ace.) Ammonii Chloridi — Troches 
of Ammonium Chloride. — Each troche contains 1.5 grains lO.ioGm.). — Dose, 1-6 
troches. 



DRUGS ACTING ON RESPIRATORY MEMBRANES. 555 

Antagonists and Incompatibles. — Therapeutically, ammonium 
chloride is antagonized by the cardiac depressants. The incom- 
patibles are — alkalies, alkaline earths and their carbonates, tartaric 
acid, mineral acids, and the soluble lead and silver salts. 

Synergists. — The expectorants, emetics, and diaphoretics en- 
hance the action of the drug. 

Physiological Action. — Externally and Locally. — Ammonium 
chloride is an irritant. 

Internally. — In medicinal doses the drug increases the secretions 
from the gastro-intestinal glands. Ammonium chloride is readily 
absorbed, and is eliminated by the kidneys, skin, bronchi, and 
mucous membranes generally, the drug being a feeble diuretic, 
diaphoretic, and expectorant. 

Save uric acid, which is slightly diminished, all the solids of the 
urine are increased under the use of ammonium chloride. The 
drug is not considered poisonous. 

Therapeutics. — Externally and Locally. — Ammonium chloride 
possesses a wide range of therapeutic applications. Solutions of 
various strengths have proved markedly efficient as local applica- 
tions in indolent buboes, epididymitis, orchitis, bruises, inflammatory 
swellings, suppurative mastitis, etc. Senile gangrene is much bene- 
fited by immersing the foot in a bath containing 8 ounces (249.0 
Gm.) of the drug to 1 gallon of water. 

A solution of 3 drams (12.0 Gm.) of ammonium chloride to 
I pint (473.17 Cc.) of water is an efficient remedy in vaginitis. 
The lotion may be used as an injection or a tampon saturated with 
the fluid and applied to the parts. 

Lozenges, solutions, or the nascent fumes of the drug have 
been found serviceable in many diseases of the nose, throat, and 
ear, such as coryza, chronic laryngitis and pharyngitis, chronic aural 
catarrh, etc. 

Internally. — Few remedies are more efficient than ammonium 
chloride in bronchitis that has passed its inflammatory stage. In 
chronic bronchitis, particularly that form occurring in old people 
and persons of a feeble habit of body, the drug is very valuable, 
either given alone or associated with stimulant expectorants. The 
remedy has appeared to be somewhat beneficial in whooping-cough. 

Contraindications. — Inflammation of the stomach, aggravated 
dyspepsia, marked emaciation, and anemia contraindicate the drug. 

Administration. — Ammonium chloride is best given in solution, 
its disagreeable taste being well disguised by the addition of some 
preparation of licorice, such as the syrup, fluidextract, or the 
aromatic elixir of licorice. In bronchial diseases the virtues of the 
drug are enhanced by this association. 

Glycyrrhiza— Glycyrrhizae— Glycyrrhiza. U. S. J\ 

(Liquorice Root.) 

Origin. — The dried root of Glycyrrhiza glabra L., or of Glycyrrhiza glandu- 
lifera (Waldstein et Killaibel),a perennial plant indigenous in the countries lying on 



556 A TEXT-BOOK OF MATERIA MEDIC A. 

the northern and southern shores of the Mediterranean and farther east through the 
Caucasus, Northern Persia, Afghanistan, and Southern Siberia to China, and cultivated 
to some extent in England, France, Germany, and the United States. 

Description and Properties. — In long, cylindrical pieces, from % to i inch 
(6-25 Mm.) thick, longitudinally wrinkled, externally grayish-brown, warty ; internally 
tawny yellow, pliable, tough ; fracture coarsely fibrous ; bark rather thick ; wood 
porous, but dense in the narrow wedges ; medullary rays linear ; taste sweet, somewhat 
acrid. The underground stem, which is often present, has the same appearance, but 
contains a thin pith. 

The drug derived from the G. glandidifera (so-called Russian liquorice) consists 
usually of roots or root branches 1-4 inches (2-10 Cm.) thick and 8-12 inches (15-30 
Cm.) long, frequently deprived of the corky layer, the wood rather soft and usually 
more or less cleft. 

Liquorice contains a glycoside, glycyrrhizin, besides asparagin, glycyramarin, an 
acrid resin, starch, gum, etc. 

Dose. — 15-60 grains (1-4 Gm.) [30 grains (2 Gm. ), U. S. P.]. 

Official Preparations. 

Fluidextractum Glycyrrhizae — Fluidextracti Glycyrrhizae — Fluidextract of 
Glycyrrhiza. — Dose, 15-60 minims (1.0-4.0 Cc). 

Extractum GlycyTrhizse — Extracti Glycyrrhizae — Extract of Glycyrrhiza. — 
Dose, freely. (Extract of glycyrrhiza is contained in trochisci ammonii chloridi and 
trochisci glycyrrhizae et opii.) 

Extractum Glycyrrhizae Purum — Extracti Glycyrrhizae Puri — Pure Extract 
of Glycyrrhiza. — Dose, freely. 

Glycyrrhizinum Ammoniatum — Glycyrrhizini Ammoniati — Ammoniated 
Glycyrrhizin. — Description and Properties. — Dark-brown or brownish-red scales, 
without odor and having a very sweet taste ; readily soluble in water and alcohol. 

Dose, — 5-15 grains (0.3-1.0 Gm.) [4 grains (0.25 Gm.), U. S. P.]. 

Mistura Glycyrrhizae Composita — Mistura Glycyrrhizae Compositae — Com- 
pound Mixture of Glycyrrhiza (Brown MIXTURE*. — Formula: Pure extract of 
glycyrrhiza, 30; syrup, 50; acacia, 30; camphorated tincture of opium, 120; wine 
of antimony, 60; spirit of nitrous ether, 30; water, to 1000. 

Dose. — 1-4 fiuidrams (4.0-15.0 Cc. ) [2 fluidrams (8 Cc), U. S. P.], 

Pulvis Glycyrrhizae Compositus — Pulveris Glycyrrhizae Compositi — Com- 
pound Powder of Glycyrrhiza. (See Senna.) 

Besides the foregoing compounds, glycyrrhiza forms an ingre- 
dient of eleven other official preparations. 

Physiological Action and Therapeutics. — The drug when 
chewed increases the flow of saliva. It is demulcent and laxative, 
and possesses slight stimulating properties when locally applied. 
It favors the secretions of the congested mucous membrane of the 
respiratory passages. 

Liquorice is used chiefly for its demulcent properties in sore 
throat, hoarseness, pharyngeal cough, acute bronchitis, etc. It has no 
general action. It is nothing more than a pleasant-tasting demul- 
cent, but, being so frequently combined with cough mixtures, has 
acquired a vicarious reputation as an expectorant. The compound 
mixture is a very efficient remedy in bronchitis. 

The various preparations of liquorice are serviceable in conceal- 
ing the taste of nauseous and bitter medicines and as an excipient 
for pills. 

Administration. — There are no special directions to be given — 
any of the preparations may be used. 



DRUGS ACTING ON RESPIRA TORY MEMBRANES. 557 

Senega— Senegae— Senega. TJ. S. JP. 

Origin. — The dried root of Polygala Senega L., a plant indigenous in North 
America, from Canada southward to South Carolina and westward to Wisconsin. 

Description and Properties. — About 4 inches (10 Cm.) long, with a 
knotty crown and spreading, tortuous branches, peeled when dry, fleshy and round 
after having been soaked in water ; externally yellowish-gray or brownish-yellow ; 
bark thick, white within, enclosing an irregular, porous, yellowish wood ; odor slight, 
unpleasant ; taste sweetish, afterward acrid. Senega contains senegin, also known as 
saponin, an acrid principle to which the medicinal property of the drug is due, besides 
a fixed and a volatile oil. 

Dose. — 10-30 grains (0.6-2.0 Gm.) [15 grains (1 Gm.), U. S. P.J. 

Official Preparations. 

Fluidextractum Senegae — Fluidextracti Senegae — Fluidextract of Senega. 
— Dose, 10-30 minims (0.6-2.0 Cc.) [15 minims (1 Cc), U. S. P.]. 

Syrupus Senegae— Syrupi Senegae — Syrup of Senega (20 per cent, of fluid 
extract). 

Dose. — 30-60 minims (20-4.0 Cc. ) [1 fluidram (4 Cc), U. S. P.]. 

Syrupus Scillae Compositus — Syrupi Scillae Compositi — Compound Syrup 
of Squill (contains 8 per cent, of Senega). (Described under Scilla.) 

Physiological Action. — Externally and Locally. — The active 
principle of senega is a decided irritant to the skin and mucous 
membranes, causing violent sneezing and cough, with marked 
hydremia and increased secretion from the bronchial and nasal 
mucous membranes when the powder is inhaled. 

Internally. — Digestive System. — Small doses stimulate the mu- 
cous membranes of the mouth and stomach, augmenting the sali- 
vary and gastric secretions, although frequently occasioning indi- 
gestion. Large doses irritate the alimentary canal, producing 
vomiting, diarrhea, and abdominal pain. 

Circulatory System. — Small doses have little action. 

Nervous System. — Under medicinal doses no important action 
has been noted. 

Respiratory System. — Excretion of the drug through the bron- 
chial mucous membrane irritates the respiratory passages, occasion- 
ing hyperemia, increased secretion, and, reflexly, cough. 

Absorption and Elimination. — The active principle of senega is 
absorbed with difficulty, being excreted through the bronchial 
mucous membrane and the kidneys, irritating these structures 
during the process, and consequently acting as a stimulant, expec- 
torant, and diuretic. The drug also possesses some diaphoretic 
virtue, being partially excreted by the skin. 

Untoward Action. — Immoderate, and in certain susceptible sub- 
jects small, doses of senega have produced irritation and burning 
in the throat, salivation, impaired appetite, a sense of oppression in 
the stomach, nausea, vomiting, colicky pains, and profuse diarrhea. 

Poisoning. — Senega is not regarded as a poisonous drug, exces- 
sive doses producing symptoms analogous to those of " Untoward 
Action," save that they are intensified. It should be remembered, 
however, that saponin and sapotoxin, which are found in senega, as 
also is sarsaparilla, quillaja, caulophyllum, and dulcamara are very 



558 A TEXT-BOOK OF MATERIA MEDICA. 

active blood poisons and may cause rapidly fatal poisoning. The 
saponins are common, moreover, in the solanaceous plants, and are 
responsible for poisoning from unripe tomatoes, sprouting potatoes,, 
and egg-plant. 

Treatment of Poisoning. — Elimination is to be favored, and the 
symptoms treated as they appear, gastric, sedatives, anodynes, and 
cardiac stimulants being employed. 

Therapeutics. — Externally and Locally. — No action has been 
observed. 

Internally. — The principal use of senega is that of a stimulating 
expectorant. It is highly beneficial in subacute bronchitis when the 
power to cough is feeble. In like manner senega is useful in bron- 
chorrhea and chronic bronchitis with profuse expectoration, though 
less valuable when the mucus is tough and scanty. 

The simple catarrhal laryngitis following croup is greatly re- 
lieved by the administration of senega. 

The drug is an appropriate remedy in amenorrhea the result of 
passive uterine congestion, and senegin has been recommended as 
a remedy for uterine hemorrhage. 

Contraindications. — Senega is inadmissible in acute bronchitis 
and indigestion, or when there is marked irritation and inflamma- 
tion of the gastro-intestinal tract. 

Administration — The syrup of senega is the preparation usually 
employed as an expectorant. Senegin may be given in doses of 2 
grains (0.13 Gm.) in capsules. 

Sanguinaria— Sanguinariae— Sanguinaria. 77. S. JP. 

( Blood-root.) 

Origin. — The dried rhizome of Sangiiinaria Canadensis L., a low perennial, a 
native of Canada and the United States, where it grows in open woods in a rich soil. 
The rhizome should be collected in autumn. 

Description and Properties. — Of horizontal growth, about 2 inches (5 
Cm.) long and \ inch (I Cm.) thick, cylindrical, somewhat branched, slightly annulate, 
wrinkled, reddish-brown ; fracture short, somewhat waxy, whitish, with numerous 
small red resin-cells, or of a nearly uniform, brownish-red color ; bark thin ; odor 
slight ; taste persistently bitter and acrid. It contains a colorless alkaloid, sanguina- 
rine, yielding red salts; chelerythine, yielding lemon-yellow salts; homochelidonine; 
and protopine. 

These alkaloids are closely relatad to the opium series. 

Dose. — 2-20 grains (0.12-1.2 Gm. ) [2 grains (0.125 Gm.), U. S. P.]. 

Official Preparations. 

Fluidextractum Sanguinariae -Fluidextracti Sanguinariae — Fluidextract 
of Sanguinaria. — Dose, 5-15 minims (0.3-1.0 Cc.) [i£ minims (o. I Cc), U. S. P.]. 

Tinctura Sanguinariae (10 per cent.) — Tincturae Sanguinariae — Tincture of 
Sanguinaria. — Dose, 10-60 minims (0.6-4.0 Cc.) [15 minims (1 Cc. ), U. S. P.). 

Physiological Action. — Externally and Locally. — Sanguinaria is 
an irritant and a feeble escharotic. When the powder of blood-root 
is inhaled it produces great irritation of the respiratory passages, 
with excessive secretion and violent sneezing. 



DR UGS A CTING ON RESPIRA TOR Y MEMBRANES. 559 

Internally. — Digestive System. — Medicinal doses occasion a 
sense of constriction in the throat and heat in the epigastrium, 
increasing the secretions from the stomach, liver, and intestines. 
Excessive doses are followed by marked salivation, nausea, and 
vomiting, the drug acting as a systemic emetic. Very large 
doses cause great irritation of the intestines, producing hyper- 
catharsis. 

Nervous System. — Large doses diminish reflex excitability by 
paralysis of the spinal centers, occasionally producing convulsions 
of spinal origin, resembling those caused by thebaine. 

Circulatory System. — At first the heart's action is increased and 
arterial tension raised, but these effects are followed by cardiac and 
circulatory depression. Poisonous doses sometimes result m car- 
diac paralysis. 

Respiratory System. — Medicinal doses of sanguinaria have no 
apparent effect upon the respiration ; poisonous doses, however, 
render the breathing slow and shallow, death resulting from as- 
phyxia due to paralysis of the respiratory center. The final col- 
lapse is often preceded by convulsions arising from the accumula- 
tion of carbon dioxide in the blood from failure of respiration. 

Blood-root is a stimulant expectorant, increasing the secretion 
from the bronchopulmonary mucous membrane. 

Poisoning. — Blood-root is an acrid narcotic poison, exciting sali- 
vation, violent vomiting, profuse watery evacuations from the 
bowels, and producing all the symptoms of gastro-ententis. The 
muscular system is greatly relaxed, the pulse is slow, weak, and 
irregular, the skin covered with cold sweat, and finally, collapse of 
the vital powers supervenes. Convulsions may precede a fatal ter- 
mination, which is due to paralysis of the respiratory or cardiac 
center. 

Treatment of Poisoning. — The stomach should be washed out 
and diffusible stimulants freely given. Strychnine may be admin- 
istered hypodermically, and digitalis and amyl nitrite given if 
necessary. The pain and nausea may be relieved by morphine and 
atropine. The normal temperature of the body should be main- 
tained by external warmth. 

This drug is now seldom used locally, the irritation caused by 
it being so great that patients can only with great difficulty be per- 
suaded to submit to the treatment. 

Internally. — While possessing alterative properties and classed 
among the specifics, one of the principal uses of sanguinaria is in 
acute bro?ic Iritis, when the spasmodic element predominates and 
after the subsidence of the more acute symptoms. 

In atonic conditions of the stomach and bowels, with increased 
secretion of mucus, small doses of tincture of sanguinaria prove 
beneficial. The tincture is of equal value in d?wdenal catarrh with 
jaundice. 

As an emmenagogue and aphrodisiac blood-root has been suc- 
cessfully employed in ftinctional amenorrhea and dysmenorrhea, as 



560 A TEXT-BOOK OF MA TERTA MEDICA. 

well as in functional impotence with relaxation of the genital organs 
and daily sejninal losses. 

Contraindications. — No special contraindication exists, unless 
it be an acute inflammatory condition of the stomach and bowels. 

Sanguinaria has practically gone out of use, as it is too irritating 
and " old fashioned " a drug. 



DRUGS ACTING PARTICULARLY ON THE KIDNEYS. 



DIURETICS. 



Diuretics are drugs which increase the flow of urine. Con- 
sidered in a broader sense, however, these agents augment the 
secretion and modify the character of the urine : 

1. By increasing the amount. 

2. By rendering the urine acid. 

3. By rendering the urine alkaline. 

4. By removing waste products or increasing the solid con- 
stituents of the urine. 

By preventing the decomposition of the urine. 

The last-named action is peculiar to benzoic * and salicylic * 
acids, cubeb, copaiba, uva ursi, oil of sandalwood, volatile oils, * 
saccharin, hexamethylenamina, and salol. 1 

The following medicines affecting the urinary system are called 
Lithoniriptics , because of their supposed power to prevent the 
formation of concretions in the urinary passages or to dissolve 
them when formed : 

Piperazin, potassium salts,* lithium salts,* ammonium benzoate,* 
benzoic acid,* dilute nitric acid.* 

Among the principal drugs which render the urine acid are — 
benzoic * and salicylic acids,* and many of their salts, immoderate 
amounts of the vegetable acids,* and sour wines.* 

The alkalies,* particularly the potassium and lithium salts, when 
taken internally, render the urine alkaline in reaction. 

Diuretics may be either direct or indirect — i. e., they may act 
on the kidneys themselves or upon certain structures outside the 
kidneys. The structures in the kidneys which have to do with 
the elimination of water, solids, etc., are: 1. The Malpighian tufts, 
which eliminate principally water, but also mineral salts and certain 
pathological and foreign substances which may be present. 2. The 
glandular epithelium lining the convoluted tubules, which excretes 
waste-products, such as urea, etc. 3. The constricted portion of the 
tubules, serving to prevent (according to the Cohnheim-Bauman 
theory) the too-rapid escape of water, thus allowing time for its 
absorption in cases where it is desirable that the water be retained 
in the system. 

The functional activity of these various structures is regulated by 

the nervous mechanism through its influence upon the blood-supply. 

For example, the supply of blood to the glomeruli is influenced 

l The drugs marked with an asterisk (*) are described elsewhere in the present work. 

36 561 



562 



A TEXT-BOOK OF MATERIA MEDICA. 



largely by the size of the blood-vessels, regulated by the vasocon- 
strictor and vasodilator nerves ; but it has not been proved that the 
secretory cells are in any way affected by the nervous mechanism. 
Diuretics act : 

1. By increasing the general blood-pressure. 

2. By causing local dilatation of the renal arterioles. 

3. By directly stimulating the glandular secreting renal structures. 

4. By simple mechanical force. 

The following table, modified from Brunton's work on Pharma- 
cology ', Therapeutics, and Materia Medica, serves to elucidate the 
methods by which the various diuretic agents probably exert their 
influence : 





- 




' Increased cardiac 


Digitalis,* 








action. 1 Alcohol.* 










' Digitalis,* 






Generally . . - 


General vascular 
contraction. 


Strophanthus,* 
Squill, 
Scoparius,* 
Convallaria,* 


Raise arterial 






Strychnine,* 
Caffeine,* 


pressure. 






Erythrophleum 
(cold to the skin). 








'Act on the vaso- j Same ^ above ? 
motor centers. J 












Contract effer- 




Scoparius,* 






ent vessels. 


Locally on kidney. * 


Buchu, 
Uva Ursi, 
Juniper, 


Locally on kidneys. - 




Turpentine, 

Copaiba, 

Cantharides.* 






Act either on vaso- 






Dilate efferent 


motor centers or 


Nitrites* 




vessels. 


locally on renal 
vessels. 


Alcohol.* 




: 


Urea, 




Increase water excreted - 


Caffeine,* 

Diuretin, 

. Calomel.* 


Act on secreting 




Colchicum,* 


nerves and renal ■ 




Liquor Potassae,* 


cells. 




Potassium Acetate,* 




Increase water and solids excreted . h 


Potassium Citrate,* 
Potassium Nitrate,* 
Sodium Citrate * 
and other salines. 




r Water, local bleeding, 


Rv ^imnlp rnf*rV»^»Tii^a 


1 action .... ... -J drv cunniner. warm 


*-* 1 r>itjiiii<w i 1 n_ v- 








fomentations. 



DRUGS ACTING PARTICULARLY ON THE KIDNEYS. 563 

The secretion of urine is considerably influenced by the activity 
of the skin and bowels ; for instance, when the cutaneous glands 
are stimulated and there is free perspiration, a diminished urinary 
secretion ensues. The functional activity of the skin and sudor- 
iparous glands depends greatly upon the amount of blood sup- 
plied to them. Whatever augments the flow of blood to these 
structures increases the secretion of the sweat-glands. Conse- 
quently, external warmth dilates the cutaneous blood-vessels and 
promotes diaphoresis, while cold contracts the cutaneous vessels, 
diverting the flow of blood to the internal organs, thereby increas- 
ing the secretion from the kidneys and lessening that from the 
skin. 

It will be seen, therefore, that the functions of the skin and 
kidneys are compensatory, the compensation being also partially 
observable in the mutual relations between the bowels and kidneys. 
It is well known that when there is active purgation, with frequent 
watery movements from the bowels, the amount of urine secreted 
is proportionally diminished. 

Any drug which increases the general blood-pressure and forces 
a larger blood-supply into the kidneys augments the pressure in 
the glomeruli, distending the capsule and enlarging the area of the 
osmotic membrane, which action, combined with an increase in the 
circulation, promotes and facilitates filtration, thereby augmenting 
the amount of urine. 

The blood-pressure in the glomeruli, as has been said, may be 
increased by additional pressure in the general circulation. It may 
be raised also locally through dilatation of the afferent blood-vessels 
supplying the Malpighian corpuscle, or contraction of the efferent 
vessels, allowing a smaller quantity of blood to escape from the 
glomerules. 

The secreting structures of the convoluted tubules are stimu- 
lated by the influence of certain drugs which are carried in the 
blood, acting as excitants upon the secreting cells. This neces- 
sarily requires an extra supply of blood to the part furnishing 
material for the extra secretion. 

The imbibition of large amounts of water, while increasing the 
blood-pressure to some extent, mechanically increases the amount 
of water eliminated by the kidney. This is commonly known as 
the " flushing action," and renders the urine more dilute. 

In congested conditions of the kidneys certain remedial meas- 
ures — such as local venesection, dry cupping, warm fomentations, 
etc. — promote renal secretion. 

Therapeutics — 1. To remove excessive accumulation of fluid in 
the tissues and serous cavities of the body when the blood-pressure is 
low. 

For this purpose the most efficient service is derived from the 
use of drugs which act by increasing the systemic blood-pressure, 
and stimulating the secreting cells of the kidneys. 

Ordinarily, the agents most beneficial in cardiac dropsy or drop- 



564 A TEXT-BOOK OF MA TERIA MEDICA. 

sies due to venous congestion are digitalis, calomel, scoparius, 
squill, diuretin, etc. 

2. To remove excess of fluid from the body when the blood-pressure 
is about normal, as in cases of hepatic cirrhosis with dropsy. 

The remedies found to be most efficient in these conditions are 
diuretin, copaiba, and calomel, although frequently saline purga- 
tives, by ridding the peritoneal cavity of excess of water and pre- 
venting the accumulation of fluid by lowering the abnormally high 
blood-pressure in the portal circulation, prove more beneficial than 
diuretics. 

3. To remove water from the blood when the arterial pressure is 
abnormally high. 

For this purpose diuretics are indicated in the early stages of 
many acute diseases, such as the eruptive fevers, tonsillitis, bron- 
chitis, etc. In these cases agents which dilate the cutaneous blood- 
vessels, such as spirit of nitrous ether, etc., should be employed. 
Diaphoretics and cathartics are likewise beneficial. 

4. To remove injurious waste products and poisonous substances 
from the blood. 

For this purpose drugs which stimulate the convoluted tubules 
and increase oxidation should be given, such as potassium nitrate 
and bitartrate, the lithium salts, turpentine, juniper, diuretin, and 
the remedies mentioned under Lithontriptics. 

The foregoing remedies will be found useful in diseases asso- 
ciated with rheumatic, gouty, and uric-acid diathesis, as well as in 
many acute diseases where there is rapid accumulation of deleteri- 
ous, catabolic material. 

5. To lessen the acidity of the urine. 

The alkalies and the alkaline salts of the organic acids are the 
most useful agents for this purpose, being serviceable in such con- 
ditions as gonorrhea and acute inflammatory states of the genito- 
urinary tract. In debilitated conditions there is quite often an ex- 
cessive acidity of the urine, irritating the mucous membrane and 
causing frequent micturition. In such cases the alkaline diuretics 
or alkaline mineral waters are of service. 

6. To increase the acidity of the urine. 

This is necessary when, from any cause, there is ammoniacal 
decomposition of the urine, as in cystitis. In such cases benzoic 
acid is probably the most beneficial remedy, though the salicylates, 
salol, and the volatile oils, etc., may also prove useful. 

7. To prevent the formation of urinary concretions or to dissolve 
them when formed, as in cases of renal calculi, etc. 

For these purposes the drugs included under LitJiontriptics 
are the most efficient. 

8. To dilute the urine. 

This process is necessary to prevent the deposit of urinary solids 
from forming calculi in the kidneys or bladder. For this purpose 
water or the alkaline mineral waters, taken in large quantities, will 
prove most useful. 



DRUGS ACTING PARTICULARLY ON THE KIDNEYS. 565 

Administration. — Diuretics are often very uncertain in their 
action, in health many of them apparently exerting no influence 
upon the kidneys, and in diseased conditions not infrequently 
proving inert. They are more certain in their action when em- 
ployed in combination — that is, a union of drugs which act both 
generally upon the systemic circulation and locally upon the 
various secreting structures of the kidneys. Diaphoretics, being 
diverse in their action, should not be given with diuretics. 

When administered, diuretics should be freely diluted with 
water. The patient's skin should be kept cool and the bowels 
prevented from acting too freely, in order that the full benefit of 
this class of remedies may be obtained. 

The diuretic drugs not described elsewhere in the present work 
are herewith considered in detail. 

Diuretin— Diuretin— Diuretin. {Non-official.) 

(SODIOSALICYLATE OF THEOBROMINE.) 

Origin. — The name indicates the origin, the drug being a chemical combination 
of theobromine (49.7 per cent.) and salicylic acid (38. 1 per cent.). It is, in reality, a 
mixture of theobromine and sodium salicylate. 

Description and Properties. — A white powder, soluble in less than half its 
weight of hot water, the solution remaining perfect on cooling. Sparingly soluble in 
cold water ; soluble in warm alcohol ; insoluble in chloroform or ether. The drug has 
a disagreeable, soap-like taste, and undergoes decomposition when exposed to the air. 

Dose. — 15 grains (1.0 Gm.) ; 45 to 105 grains (2.9-7.0 Gm.) maybe given in 
divided portions in twenty-four hours. 

Synergists. — The therapeutic influence of the drug would 
theoretically be enhanced by caffeine, digitalis, and many of the 
cardiac stimulants and diuretics. 

Physiological Action. — Externally and Locally. — There is none. 
Theobromine, being a xanthin derivative, has the action of that 
series of compounds. See Caffeine. 

Internally. — Digestive System. — Diuretin has no important ac- 
tion, though in many cases it may cause disturbance of digestion, 
impair the appetite, and even occasion nausea, vomiting, and 
diarrhea. 

Nervous System. — Large and continued doses frequently occa- 
sion headache, somnolence or insomnia, with buzzing in the ears, 
and symptoms resembling those produced by the salicylates. The 
xanthin action is to stimulate the vasomotor centers, and slight 
stimulation of the respiratory center. Theobromine is one of the 
least stimulating xanthins and shows little of this action. 

Circulatory System. — The drug has a very beneficial action 
upon the system in failing compensation and edema, its favorable 
influence being due to its effect upon the kidneys. Theobromine, 
like caffeine, exercises a direct, stimulating action upon the renal 
epithelium and also a very slight stimulating effect upon the vaso- 
motor center in the medulla. 



566 A TEXT-BOOK OF MA TERIA MEDICA. 

Repiratory System. — Diuretin exerts no direct influence upon 
the respiratory system. Yet dyspnea, bronchitis, etc., the result 
of a dropsical condition, are relieved by the administration of the 
drug. 

Absorption and Elimination. — Diuretin is somewhat rapidly ab- 
sorbed, being eliminated mainly by the kidneys, the process greatly 
stimulating the renal epithelium. The rise in blood-pressure is 
helpful, but the chief action has been shown to be on the renal 
epithelium. Both fluid and solid parts are increased. The chief 
increase in solids taking place in the chlorides. The amount of 
nitrogenous matter eliminated is also increased. 

In cases where diuretin is indicated the amount of urine is 
increased from three- to sixfold in twenty-four hours, under its 
administration the diuretic action of the drug gradually reaching 
its maximum between the second and third days. In the case of 
healthy persons diuretin has little influence upon the amount of 
urine excreted. 

Untoward Action. — In certain individuals the drug causes great 
disturbance of the gastro-intestinal tract, such as nausea, vomiting, 
diarrhea, palpitation of the heart, headache, and slight fever ; occa- 
sionally cutaneous eruptions may be present. 

Poisoning. — No cases of poisoning are recorded. 

Therapeutics. — The drug is used exclusively as a diuretic in 
cases of dropsy, ascites, pleuritic effusion, etc. 

Diuretin is worthy of a thorough trial for the removal of drop- 
sical fluids, irrespective of the cause. 

Diuretin is best suited to cases in which there is general drop- 
sical effusion. It is the best medicinal remedy for removing drop- 
sical fluid due to valvular disease of the heart after digitalis and 
pure cardiac tonics have failed. Diuretin has oftentimes a bene- 
ficial effect in other circulatory diseases with dropsy, as myocarditis, 
pericarditis, aneurism^ arteriosclerosis. Its action is here more 
uncertain than in valvular disease. In the dropsy of nephritis it 
can be used without danger of irritating the kidney, the effects in 
acute nephritis being more certain than in chronic nephritis. Where 
the renal epithelium has undergone too extensive degeneration the 
drug may fail to act. In the dropsy of portal obstruction, and 
especially of cirrhosis of the liver, it usually fails to give good 
results. 

Contraindications. — There are no special contraindications to 
the use of diuretin, unless it be in cases of marked gastric irritation, 
when the drug would undoubtedly aggravate the symptoms. 

Administration. — Diuretin may be given in capsules or dis- 
solved in some aromatic water or in milk. It should never be 
dispensed in powders, since it absorbs carbonic acid from the air 
and undergoes decomposition. 

It is preferable to give the drug in solution ; and it can be easily 
associated with digitalis and similar remedies, but when used with 
the cardiac remedies the doses of diuretin should be smaller. 



DRUGS ACTING PARTICULARLY ON THE KIDNEYS. 567 

When giving this drug in cases of marked ascites, or for the 
removal of large quantities of dropsical fluid, the first doses should 
be small and gradually increased to the maximum amount or until 
the desired effect be produced, lest by a too sudden removal of the 
fluid alarming collapse ensue. 

As acids are incompatible with the drug, diuretin should not be 
given immediately after meals, but its administration postponed for 
about three hours to avoid unpleasant symptoms arising from the 
action of the gastric juice upon the remedy. 

The practice of adding fruit syrups or juices to a solution of 
diuretin for the purpose of rendering it more palatable should be 
strictly avoided, since the theobromine is precipitated by the vege- 
table acids as a thick white sediment. 

The maximum daily amount which can be safely administered 
is 150 grains (9.72 Gm.). The average daily amount is 45 to 105 
grains (2.9-7.0 Gm.), given in divided doses of about 15 grains 
(1.0 Gm.) each. 

If diuresis is not increased in six days, the use of the drug 
should be suspended and recourse to other treatment adopted. 

Piperazinum— Piperazini— Piperazin. (Non-ofiicial.) 

(PlPERAZIDINE ; ETHYLENEIMINE; DlETHYLENEDIAMINE ; DlSPERMINE.) 

Origin. — Obtained by the action of ammonia on bromide or chloride of ethylene, 

nh <ch:_Zch 2 >h. 

Description and Properties. — It occurs as a crystalline solid, exceedingly 
soluble in water, the solution being practically tasteless. When exposed to the air the 
drug is very deliquescent, becoming completely liquefied on long exposure. 

Dose. — 5-15 grains (0.3-1.0 Gm.). 

Piperazin, Lycetol, Lysidine, and Urotropine are closely re- 
lated compounds, all introduced to dissolve uric acid in the body. 
Since a partial death blow has recently been administered to the 
" uric-acid phobia," the therapeutic facilities in this line are less 
sought after. What is here written of piperazin is probably true 
of this entire series of bodies. 

Physiological Action and Therapeutics. — -The drug apparently 
has no effect whatever upon either the digestive, circulatory, or 
respiratory systems. Excessive doses, however, have affected the 
nervous system, producing certain untoward manifestations, such 
as muscular tremors, hallucinations, and clonic spasms. 

The drug is non-irritating when applied to mucous membranes. 

Piperazin is rapidly absorbed from the stomach, circulates in 
the blood unchanged, and is eliminated in the urine. 

The only important action of piperazin is its property of dis- 
solving uric acid, with which it forms a neutral and exceedingly 
soluble salt, piperazin urate, said to be seven times more soluble in 
water than lithium urate. This action is prominent in test-tubes, but 
it is highly doubtful if it is as serviceable in the human body. 



568 A TEXT-BOOK OF MATERIA MEDICA. 

Therapeutics. — Externally and Locally. — A solution of pipera- 
zin (i to 2 per cent.) in a mixture of water and alcohol (i to 4, re- 
spectively) has been applied locally to gouty joints and swellings 
with doubtful results. 

Solutions of piperazin may be injected into the bladder in order 
to dissolve vesical calculi. They seem to have a slight action. 

In the treatment of gout some observers have reported good 
results. For renal and vesical calculi of the urates it is doubtful if 
this drug is of much service, yet it is worthy of extended trial. It 
is of service in chronic cystitis and in some forms of arthritis. The 
pruritus of diabetes is often benefited by it. 

The good results which have been reported from the use of 
these uric-acid solvents is largely to be attributed to the immense 
quantities of water with which their administration is combined. 

Contraindications. — None of importance can be named. 

Administration. — Piperazin is best given in aerated water, 
although it may be acceptably administered in distilled water and 
syrup, orange flower water, or other agreeable vehicle. 

Hexamethylenamina— Hexamethylenaminae— 
Hexamethylenamine. U. S. I*. 

Definition. — A condensation product of formaldehyde and ammonia, (CH 2 ) 6 N r 
Chemically it is hexamethylene-tetramine. Also known as aminoform, ammonio- 
form aldehyde, cystamine, cystogen, formin, ziritone, and urotropin. 

Description and Properties. — Colorless, lustrous, odorless crystals, having 
a sweetish, then somewhat bitter, taste. Its aqueous solution has an alkaline reaction 
to litmus-paper. Easily soluble in water (i : 1.5), less so in alcohol (1 : 10). In 
solution it is decomposed by dilute sulphuric acid with liberation of formaldehyde ; it 
is precipitated by tannic acid and mercuric chloride. 

Dose. — Average dose : 4 grains (0.250 Gm.) = 250 milligrammes, U. S. P. 

Allied Compounds. 

Hexamethylene-tetramine readily forms compounds with a large number of sub- 
stances; among those suggested for use in medicine the following may be mentioned : 

Hexamethylenamine salicylate, urotropin salicylate, or saliformin ; a color- 
less, crystalline powder of nauseous, sweetish, astringent taste. 

Hexamethylenamine-ethylbromide, bromalin, or bromoformin ; a colorless, 
crystalline powder of a sweetish, saline taste. 

Hexamethylenamine-tannin, tannopin, or tannon ; a brown, tasteless powder, 
nearly insoluble in water and alcohol. 

Dioxybenzol-hexamethylenamine, hetralin, contains 60 per cent, of hexa- 
methylenamine. 

Chinotropin and chinoformin are quinates of hexamethylenamine. Helmitol is 
a recently introduced compound of hexamethylenamine with anhydromethylene citric 
acid. Citarin (sodium anhydromethylene citrate) is another compound from which 
formaldehyde is split off in the organism. 

Therapeutics. — The chief action of hexamethylenamina is to 
act as a germicide in the urine. It is eliminated in the urine and 
broken down as formaldehyde. It is particularly valuable in cys- 
titis, in gonorrhea, in typhoid fever, and in all conditions in which 
it is desired to avoid urinary infection or to lessen its severity. 



DIAPHORETICS. 



Diaphoretics — or sudorifics, as they are also called — are medi- 
cines which promote diaphoresis or sweating. Their action in 
stimulating transpiration by the skin may be enhanced by exercise, 
external warmth, nauseants, and drugs which dilate the vessels, 
determining more blood to the cutaneous blood-vessels. 

Diaphoretics are employed principally for their evacuant, revul- 
sive, and alterative effects, and to promote absorption. Some of 
the drugs here considered might be classed with those whose chief 
action is on the spinal cord. Toxicologically they affect the cord — 
therapeutically they are used mainly as diaphoretics. This is par- 
ticularly true of pilocarpus and physosttgma. 

Pilocarpus— Pilocarpi— Pilocarpus. U. S. JP. 

(Jaborandi.) 

Origin. — The leaflets of Pilocarpus Jaborandi Holmes or of Pilocarpus micro- 
phyllus Stapf., yielding not less than 0.5 per cent, of alkaloids. 

Description and Properties. — Pilocarpus contains a volatile oil and two 
alkaloids, pilocarpine and jaborine, the latter being thought to be chemically isomeric 
with the former. 

Pilocarpidine, in many ways the equivalent of pilocarpine, has recently been isolated. 

Dose. — 5-60 grains (0.3-4.0 Gm.). 

Official Preparations. 

Fluidextractum Pilocarpi — Fluidextracti Pilocarpi — Fluidextract of Pilo- 
carpus. — Dose, 5-60 minims (0.3-4.0 Cc). 

Pilocarpinse Hydrochloridum — Pilocarpinse Hydrochloridi — Pilocarpine 
Hydrochloride. — Origin. — The hydrochloride of an alkaloid obtained from pilocarpus. 

Description and Properties. — Small, white crystals, odorless, and of a faintly bitter 
taste ; deliquescent on exposure to damp air. Very soluble in water and in alcohol. 
It should be kept in small, well-stoppered bottles. 

Dose. — -Jj-i grain (0.001-0.03 Gm.). 

Pilocarpinse Nitras — Pilocarpinae Nitratis — Pilocarpine Nitrate. — Definition. 
— The nitrate (C n H 16 N 2 2 .HN0 3 ) of an alkaloid obtained from pilocarpus. 

Character. — In colorless, or white, shining crystals, odorless, and having a faintly 
bitter taste. It is permanent in the air, whereas the hydrochloride is deliquescent on 
exposure to the air. Soluble in water (1 : 4), alcohol (1 : 60), warm alcohol (1 : 16). 

Dose. — Average dose : \ grain (0.0 10 Gm. = 10 milligrammes, U. S. P. 

Antagonists and Incompatibles. — Atropine is a physiological 
antagonist to pilocarpine, being directly opposite in its action 
throughout its entire range, y^- grain (0.0006 Gm.) being sufficient 
to counteract \ grain (0.0 1 Gm.) of pilocarpine. Morphine relieves 
the nausea. 

The incompatibles are tannic acid, caustic alkalies, and the ferric 
and metallic salts. 

569 



570 A TEXT-BOOK OF MATERIA MEDIC A. 

Physiological Action. — Externally and Locally. — There is no 
action of importance. 

Internally. — Digestive System. — The action of pilocarpine is here 
given, since the alkaloid fully represents the drug. 

When pilocarpine is taken into the mouth, the ends of the 
chorda tympani and secretory nerves are stimulated, causing an 
increased secretion of saliva. Should large doses be taken, there 
is a feeling of tenderness in the mouth and severe salivation is 
produced. There is also a marked increase in the flow of tears. 

The gastric glands are stimulated by the drug, their normal 
secretion being augmented. By stimulating the unstriped muscle- 
fibers pilocarpine increases peristalsis, both of the stomach and the 
intestines, in large doses acting as a cathartic. Immoderate amounts 
may also induce vomiting. The bile and pancreatic juice are not 
affected by moderate amounts of the drug. 

Nervous System. — In medicinal amounts pilocarpine has no per- 
ceptible action on the central nervous system, although stimulating 
the nerve-terminations of involuntary muscles — i. e. y those of the 
stomach, intestines, heart, spleen, bladder, uterus, etc. 

Poisonous doses have produced (in the frog) tetanic convulsions, 
followed by paralysis, the result of depression of the muscles and 
spinal centers, the nerves apparently being unaffected. 

Circulatory System. — At first the inhibitory fibers are stimulated, 
resulting in a slowed heart ; but this soon gives over to rapid and 
palpitating heart action with raised blood-pressure. 

Respiratory System. — The respiratory movements are unaffected 
by medicinal amounts, but the bronchial secretion is augmented. 

Absorption and Elimination. — Pilocarpine is rapidly absorbed, 
and is eliminated principally by the skin, occasioning free, and 
under large doses excessive, diaphoresis. 

The sweat is at first acid, then neutral, and finally alkaline in 
reaction. The diaphoresis produced by pilocarpine is due to stimu- 
lation of the secretory nerves supplying the glands. 

The kidneys, under small doses, are stimulated, there being a 
slight increase in the urine, and the amount of urea is considerably 
augmented. This may be a result of the stimulation to leucocyto- 
sis caused by this drug on the blood-forming organs. 

The drug is also eliminated by the salivary glands, there being 
frequently an enormous increase in the salivary secretion. Under 
the influence of pilocarpine there is an increase in the gastric, 
bronchial, and lacrymal secretions, even the secretion of milk 
being notably augmented. Cushny states that pilocarpine is not a 
galactagogue. 

Temperature. — Succeeding a very brief and slight elevation of 
temperature there is a decided diminution of bodily heat, resulting 
from the dilatation of cutaneous blood-vessels and the evaporation 
of the perspiration. 

Eye. — Whether applied locally to the eye or taken internally, 
pilocarpine produces marked contraction of the pupil by stimulating 



DIAPHORETICS. 571 

the peripheral endings of the motor oculi nerves. The drug pro- 
duces a primary increase of tension of the eyeball, followed by a 
more permanent diminution in tension. 

Uterus. — There is authority for the statement that pilocarpine 
stimulates the gravid uterus, inducing uterine contractions or in- 
creasing the energy of those already established. 

The effect of the drug upon the uterus, however, is more pro- 
nounced and apparent in cases of eclampsia, seeming to prove the 
fallacy of the statement that pilocarpine is a true ecbolic. 

Untoward Action. — Nausea and vomiting are of quite frequent 
occurrence, the vomiting being preceded by long and distressing 
nausea. Occasionally the patient complains of severe pain in the 
urethra and in the lumbar region, with frequent desire to micturate. 

There have often been present headache, vertigo, hiccough, 
dimness of vision, gastric and abdominal pains, stupor, and chilli- 
ness. Collapse may occur. 

Poisoning. — The symptoms produced by poisonous doses of 
pilocarpine are exaggerations of those already described, together 
with diarrhea, exhausting and excessive sweating and salivation, 
marked cardiac and respiratory depression, and collapse. 

Treatment of Poisoning. — If the drug has been ingested, the stom- 
ach should be immediately cleansed with a solution of tannic acid. 

To counteract the untoward effects of pilocarpine, whether the 
drug has been ingested or given by subcutaneous injection, atro- 
pine is undoubtedly the most complete physiological antagonist, 
and should be given hypodermically. Morphine is indicated to 
control the nausea and vomiting, while some of the cardiac stimu- 
lants may be required to counteract cardiac depression. 

Therapeutics. — Externally and Locally. — Pilocarpine, or the 
fluidextract of jaborandi, has been highly recommended for 
alopecia. By the use of pilocarpine the hair becomes darker. The 
fluidextract of pilocarpus has been employed as a local appli- 
cation in erysipelas and eczema. 

Lozenges containing -^ grain (0.00 1 Gm.) of pilocarpine are 
efficient in relieving dryness of the throat. As a myotic, pilocarpine 
is used in many diseases of the eye. 

Internally. — The principal internal use of pilocarpine is as a 
diaphoretic in Bright s disease. It eliminates through the skin many 
products, particularly fluids, that otherwise must be eliminated by 
an overtaxed kidney. In cardiac dropsy it is not a safe remedy, 
because of its depressing influence upon the heart. 

The drug is very efficient in removing pleuritic effusion, while in 
uremic poisoning it is unquestionably a valuable remedy. 

The hypodermic injection of small doses of pilocarpine has 
been highly recommended as an efficient remedy in erysipelas, par- 
ticularly during the first stages of the disease. 

The drug has proved beneficial in tobacco and alcoholic amblyopia. 

Pilocarpine has been found useful in humid asthma, bronchor- 
rhea, and hiccough, and, in small doses, in arresting the sweating of 



572 A TEXT-BOOK OF MATERIA MEDICA. 

phthisis and for the relief of ptyalism. The drug is an efficient 
galactogogue, and has been used with success in mumps, chronic en- 
largement of the cervical glands, and adenitis of the inguinal glands. 

Pilocarpine materially lessens the flow of urine in diabetes 
insipidus, and in many diseases of the eye and ear the internal use 
of the drug serves a useful purpose. 

The property possessed by pilocarpine of stimulating the 
glands of the skin renders this remedy of great service in many 
chronic diseases of the skin characterized by a dry, scaly condition. 
It is a peculiarly valuable agent in phthiriasis, psoriasis, certain 
forms of eczema, pruritus senilis, etc. Pilocarpine or fluidex- 
tract of jaborandi may be useful in breaking up a cold. 

Finally, pilocarpine has been highly recommended in catarrhal 
jaundice, and is one of the most efficient antidotes to belladonna- 
poisoni?ig. 

Contraindications. — The drug should never be employed when 
the heart is weak from thinning and atrophy of its walls or from 
fatty degeneration, nor where there is a tendency to pulmonary 
congestion and edema. The drug is also contraindicated in asthenic 
fevers, such as typhoid fever, etc. 

Administration. — Pilocarpine is superior to the crude drug, 
being far more reliable in its action and less liable to produce 
nausea and vomiting. Pilocarpine is usually given hypodermically, 
although it is frequently administered by the mouth, in solution, or 
in troches. 

Of all the preparations of the crude drug, the fluidextract and 
infusion are commonly employed, the latter being less apt to cause 
profuse salivation. An elixir of pilocarpus is prescribed consider- 
ably. 

Should preparations of jaborandi be given upon an empty 
stomach, they are less apt to occasion nausea. This inconvenience 
may be also avoided by giving an infusion by the rectum. 

Liquor Ammonii Acetatis— Liquoris Ammonii Ace- 
tatis— Solution of Ammonium Acetate. U. S. JP. 

(Spirit of Mindererus.) 

Origin. — An aqueous solution of ammonium acetate, containing about 7 per cent. 
of the salt, together with small amounts of acetic and carbonic acids. 

Description and Properties. — A clear, colorless liquid free from empyreuma, 
of a mildly saline, acidulous taste and an acid reaction. This preparation when re- 
quired should be freshly made. 

Dose. — %—\ fluidounce (15.0-30.0 Cc), in sweetened water. 

Official Preparation. 

Liquor Ferri et Ammonii Acetatis — Liquoris Ferri et Ammonii Acetatis — 
Solution of Iron and Ammonium Acetate (BASHAM'S Mixture). — Described 
under Preparations of Iron. 

Physiological Action and Therapeutics. — Solution of ammo- 
nium acetate is both a mild diaphoretic and diuretic, according as 



DIAPHORETICS. 573 

the action is governed by other more powerful agents. For instance, 
if the skin is warm and the cutaneous blood-vessels dilated, the 
preparation acts as a diaphoretic, while if the condition of the skin 
is the reverse, the action of the drug is directed to the kidneys. 
Should the preparation be given with aconite or spirit of nitrous 
ether, its action would be that of a diaphoretic, but if the drug 
were associated with digitalis or squill, it would act as a diuretic. 
In any case the action of the drug is due to a stimulation of the 
secretory cells or nerves. 

The principal medical use of solution of ammonium acetate is 
as a diaphoretic in febrile conditions, such as acute coryza, influ- 
enza, acute pharyngitis, etc. It is a very efficient remedy in mus- 
cular rheumatism, and in the eruptive fevers when the eruption is 
retarded. It is frequently associated with other remedies in the 
treatment of scarlatinous dropsy. 

Owing to its property of stimulating the heart and circulation, 
the remedy has been recommended in low forms of fever, in the 
belief that it helps to sustain the powers of life, in lowering the 
pulse and temperature, moistening the tongue, and quieting the 
delirium. 

In migraine and in alcoholic intoxication few remedies are so 
successful, the drug frequently dissipating the effects of acute 
alcoholism at once. 

The remedy has been found efficacious in dysmenorrhea and 
menorrhagia, and has been employed externally and locally as a 
discutient in mammary engorgements, glandular swellings, contu- 
sions, incipient abscesses, etc. 

Administration. — The preparation, as has been said, should be 
freshly made when wanted, and should be administered well diluted 
with sweetened water. 

Spiritus Athens Nitrosi— Spiritus Athens Nitrosi— 
Spirit of Nitrous Ether. U. S. JP. 

(Sweet Spirit of Nitre.) 

Origin. — An alcoholic solution of ethyl nitrite, yielding, when freshly prepared 
and tested in a nitrometer, not less than eleven times its own volume of nitrogen 
dioxide. 

Description and Properties. — A clear, mobile, volatile, and inflammable 
liquid, of a pale-yellowish or faintly greenish-yellow tint, having a fragrant, ethereal, 
and pungent odor free from acridity, and a sharp, burning taste. It should be kept in 
dark amber-colored, well -stoppered bottles, remote from lights and fire. 

Dose. — %-2 fluidrams (2.0-8.0 Cc). 

Physiological Action and Therapeutics. — When applied to 
the skin and allowed to evaporate, spirit of nitrous ether produces 
a slight anesthetic effect Internally, its action is very similar to 
that of the ammonium acetate. It dilates the blood-vessels more 
than the latter preparation, besides being more of a diffusible stim- 
ulant, stomachic, and carminative. 

Like the solution of ammonium acetate, spirit of nitrous ether 



574 A TEXT-BOOK OF MATERIA MEDIC A. 

acts either as a diaphoretic or diuretic, the effect depending upon 
the manner in which it is administered. For its diuretic action it 
should be given in ice-water and the patient kept cool ; to produce 
diaphoresis its administration should be accompanied by warm 
drinks and the patient be well covered. 

Spirit of nitrous ether is used for about the same purposes as 
the solution of ammonium acetate, being particularly serviceable in 
febrile affections to promote critical sweating, employed either 
alone or in combination with tincture of aconite. It is frequently 
given as a diuretic in Bright 's disease, congestion of the kidneys, and 
painful affections of the urinary apparatus. 

It is a serviceable remedy to relieve flatulent distention of the 
stomach, to allay nausea, and to quiet nervous agitation. As an 
antispasmodic the remedy is frequently employed to relieve the 
pain of dysmenorrhea, and it may be inhaled for the relief of cough- 
ing. It enters into many expectorant mixtures, and is a soothing 
application to the forehead in neuralgic headache. 

Administration. — The dose and manner of administering spirit 
of nitrous ether depend upon the action desired. As an anti- 
pyretic in febrile affections it should be given in doses of 20-30 
minims (1.30-2.0 Cc), in sweetened water, every half-hour. To 
produce diuresis the drug should be associated with some other 
diuretic and given in larger doses, \- 1 fluidram (2.0-4.0 Cc), every 
three or four hours. If the remedy is desired for its diaphoretic 
action, it should be given in hot water, in doses of 20 or 30 minims 
(1.3-2.0 Cc), repeated every half hour, the patient being well 
covered. 

Should the drug be given as a nervous stimulant, the dose 
should not be less than 1 fluidram (4.0 Cc). 

Care should be exercised in the selection of spirit of nitrous 
ether that it be reliable and of full strength. If the preparation has 
been kept in large bottles exposed to light and air, the drug will 
be more or less inert and should not be prescribed. 

Physostigrma— Physostigrnatis— Physostigrma. 

U. S. JP. 

(Calabar Bean.) 

Origin. — The seed of Physosligma venenosum Balfour, a lofty, half-shrubby, 
climbing plant (somewhat resembling the scarlet runner or Spanish bean of our gardens), 
growing near the mouths of the Niger and Old Calabar Rivers in Western Africa, and 
attaining a height of 40 or 50 feet (12-15 M.). 

Description and Properties. — The seeds are about 1 to ij( inches (25- 
30 Mm.) long, \ to f inch | 15-20 Mm.) broad, and \ to \ inch (10-15 Mm.) thick; 
oblong and somewhat reniform; testa granular, chocolate-brown, with a broad, black 
groove extending the entire length of the convex edge; embryo with a short, curved 
radicle and two large, white concavo-convexed cotyledons ; inodorous ; taste bean- 
like. 

The drug contains an alkaloid, physostigmine (also known as eserine), which is the 
principal constituent ; calabarine, to which the drug owes its tetanizing properties ; and 
eseridine (a laxative and motor excitant) ; besides a neutral principle, physosterin, 
related to cholesterin. 

Dose. — 1-4 grains (0.065-0.25 Gm.) [i}4 grains (0.1 Gm.), U. S. P.]. 



DIAPHORETICS. 575 

Official Preparations. 

Extractum Physostigmatis— Extracti Physostigmatis— Extract of Physos- 
tigma. — Dose, T ^-l grain (0.004-0.01 Gm. ) \_\ grain (0.005 Gm.), U. S. P.]. 

Tinctura Physostigmatis — Tincturae Physostigmatis — Tincture of Physos- 
tigma.— Dose, 5-10 minims (0.3-0.6 Cc.) [15 minims (1 Cc), U. S. P.]. 

The alkaloid, physostigmine, is not official. It occurs in colorless or slightly 
pinkish crystals; sparingly soluble in water ; readily soluble in alcohol. 

Dose. — rtjo-^o g rai n (0.0006-0.003 Gm.). The salicylate and sulphate of physos- 
tigmine are official. 

Physostigminae Salicylas— Physostigminae Salicylatis— Physostigmine 
Salicylate (Eserine Salicylate), U. S. P. 

Description and Properties. — Colorless or faintly yellowish, shining, acicular, or 
short, columnar crystals, odorless, and of a bitter taste ; acquiring a reddish tint when 
exposed to light and air; soluble in 150 parts of water and 12 parts of alcohol. The 
salicylate should be kept in small, dark amber-colored, and well-stoppered vials. 

Dose.—j^Q--^ grain (0.0005-0.002 Gm.) [J ? grain (0.001 Gm.), U. S. P.]. 

Physostigminae Sulphas— Physostigminae Sulphatis— Physostigmine Sul- 
phate (Eserine Sulphate), U. S. P. 

Description and Properties. — A white, or yellowish-white, micro-crystalline powder, 
odorless, and of a bitter taste. It is very deliquescent when exposed to moist air, 
gradually turning reddish in air and light. Very soluble in water and alcohol ; still 
more so at the boiling-point of these liquids. It should be kept in small, dark amber- 
colored, and well-stoppered vials. 

Dose. — x^-jVj grain (0.0005-0.002 Gm. ) [J ? grain (0.001 Gm.), U. S. P.]. 

Physiological Action. — Externally and Locally. — No external 
action of physostigma and its preparations is noted, unless it be its 
effect upon the pupil, which outward application contracts, and the 
slight abolition of functional activity in the motor and sensory 
nerves, occasioned, it is said, by a strong solution of physostigmine. 

Internally. — Digestive System. — The administration of the drug 
tends to stimulate the salivary, gastric, and intestinal secretions, 
and, by acting upon the muscular coats of the stomach and intes- 
tines, to increase peristalsis. Nausea, retching, vomiting, and purg- 
ing may result. The intestinal contractions set up are very pow- 
erful, so much so that physostigmine has been used as a remedy 
for intestinal paresis following abdominal operations. 

Nervous System. — The higher cerebral centers are not primarily 
affected by this drug in man. The medulla and cord are the main 
structures involved. After a transient stimulation depression sets 
in, the spinal reflexes being abolished, and final poisoning of the 
medullary centers occurs. 

Respiratory System. — Small doses stimulate respiration. Larger 
amounts primarily depress the respiratory centers, stimulate the 
peripheries of the pulmonary vagi, and contract the caliber of the 
bronchial tubes, even to the extent of serious constriction, death 
usually resulting from asphyxia. 

The breathing is first quickened and then retarded, the effect 
of the drug upon the respiration being more powerful than its cir- 
culatory influence, the heart continuing to beat for some time after 
pulmonary action has ceased. 

Circulatory System. — No influence on the blood has been 
detected. Small doses increase arterial tension, the heart's action 
becoming slower and stronger. 



576 A TEXT-BOOK OF MATERIA MEDICA. 

Although the effect upon the heart is somewhat obscure, it 
appears that under poisonous doses the cardiac pulsations are 
greatly reduced, being slow and feeble, and finally ceasing alto- 
gether. It is reasonably supposed that this action is due to primary 
stimulation of the peripheral vagi, influencing the cardiac ganglia, 
and also to the effect upon the vasomotor centers. The subse- 
quent exhaustion and relaxation of the arteries are doubtless the 
result of a similar influence. 

There is marked elevation of blood-pressure under moderate 
doses, although there may occur a brief period of depression. 
Toxic doses are accompanied by a notable decrease of arterial ten- 
sion, the cardiac ganglia being seized with paralysis, and the heart 
finally arrested in diastole. 

Secretions. — All of the secretions, notably the tears, sweat, saliva, 
mucous secretions, pancreas, and bile, are markedly augmented. 

TemperaUire. — A slight depression has been noted. 

Eye. — Applied locally to the conjunctiva or introduced into the 
circulation, whether by ingestion or injection, physostigmine causes 
myosis or contraction of the pupil by stimulating the peripheral 
endings of the oculomotor nerves, possibly by a depression of the 
sympathetic fibers. 

Other prominent symptoms present are spasm of accommoda- 
tion and decreased intra-ocular tension and myopia. Irritation of 
the third nerve is the principal cause of these phenomena. The 
intra-ocular pressure is lowered (i) by lessening the blood-supply 
to the eye through contraction of the blood-vessels ; (2) by dimin- 
ishing the secretion of the aqueous humor from the glands on the 
surface of the ciliary body ; (3) by contracting the iris, so that the 
aqueous humor can more readily pass through the canal of 
Schlemm. 

Unstriped Muscle. — The full influence of the drug tends to pro- 
duce uterine contractions, and it also influences the unstriped mus- 
cles of the bladder, ureter, bronchi, as well as the intestines, to 
increased contractions. 

Absorption and Elimination. — The active principles of physos- 
tigma and its alkaloids are rapidly diffused in the blood. They 
are largely excreted by the kidneys, the bile and saliva contributing 
to the process of elimination, and have been detected in the gastric 
juices after intravenous injection. 

Untoward Action. — When eserine is applied to the eye it occa- 
sionally produces a nervous contractile pain in the entire eyeball, 
which extends in a manner similar to ciliary neurosis along the 
course of the supra-orbital nerve, resembling migraine. 

Small doses have in some individuals produced nausea and 
general uneasiness, and occasionally intense pain in the epigas- 
trium. 

Poisoning. — Taken in poisonous doses, physostigma causes in 
from |-J- hour, occasionally 2 hours, nausea, giddiness, and mus- 
cular tremors and weakness, followed by complete muscular relax- 



DIAPHORETICS. 577 

ation. There are muscular tremors and intense salivation, increased 
tear-flow, and profuse perspiration. Involuntary urination and 
defecation have been observed. Cardiac action is diminished ; the 
reflexes are in abeyance ; the respiration is retarded : and myosis 
and motor paralysis are manifest. The pupils visibly contract, and 
purging and vomiting may ensue. Fatal results are possible 
through paralysis of the respiratory center and consequent 
asphyxia. The more rapid collapse succeeding the administration 
of lethal doses is due to cardiac syncope. 

Doses of 4-9 grains (0.3-0.6 Gm.) of the seed have caused 
serious symptoms. Physostigmine salicylate f grain (0.05 Gm.) 
has resulted in severe poisoning with recovery. 

Treatment of Poisoning. — The stomach should be evacuated, the 
process being followed by the hypodermic injection of a solution 
of atropine, which may prove an efficient physiological antidote. 
Tannic acid may be used as a chemical antagonist. Diffusible 
stimulants, such as ether or ammonia, may serve to arrest cardiac 
and respiratory failure. Digitalis and alcohol have also been suc- 
cessfully employed. Temperature should be maintained by the 
application of external heat. 

Therapeutics. — Externally and Locally. — Physostigmine and 
eserine sulphate are the preparations usually employed, their 
only action of importance being in diseases of the eye. They are 
of value in breaking up adhesions of the iris to the cornea or lens, 
strengthening the muscle of accommodation, reducing intra-ocular 
pressure, and removing the effects of atropine, although Jessup 
claims that complete ciliary paralysis by atropine and the mydriasis 
induced by hyoscine are unaffected by eserine. 

In certain cases of ulcer of the cornea uncomplicated with iritis 
and sloughing keratitis, where there is little inflammation or ciliary 
irritation, eserine sometimes produces prompt improvement when 
atropine has failed. 

Paralytic mydriasis and paralysis of accommodation are tempo- 
rarily relieved by this drug, and weak solutions have been employed 
with varying success in accommodative asthenopia without refract- 
ive errors. 

The remedy is of unquestioned value in the early stages of glau- 
coma, but only at the commencement of an acute attack and contra- 
indicated in the hemorrhagic form. If the drug fails to contract 
the pupil when used for glaucoma, it may induce irritating spasm 
of the ciliary muscles by increasing the blood-supply to the iris. 

Physostigmine is sometimes employed to prevent prolapsus of 
the iris, following peripheral perforation of the cornea or cataract 
extraction, particularly without iridectomy. 

The remedy serves a useful purpose also in coal-miners' nys- 
tagmus, 1 drop of a collyrium containing \ grain (0.096 Gm.) of 
physostigmine sulphate in 1 ounce (30.0 Cc.) of distilled water 
being dropped into the eye three times a day. Eserine is also 
employed in neuralgia of the eyeball and photophobia. 

37 



578 A TEXT-BOOK OF MATERIA MEDIC A. 

Internally. — Physostigma has proved efficacious in constipation 
due to an atonic condition of the intestines with deficient secretion. 
The state of the muscular intestinal layer frequently allows gas to 
accumulate in the bowels, with consequent troublesome flatulence. 
The drug, by imparting tone to the muscles and increasing peri- 
stalsis, greatly relieves this unpleasant condition. It is of inesti- 
mable value in the treatment of intestinal paresis following abdom- 
inal operations. 

Gastric and intestinal dilatation have been successfully treated 
by Hare with this remedy. It is valuable in chronic bronchitis with 
dilatation of the bronchial tubes, and is said to relieve bronchial 
asthma and emphysema. 

It has been recommended in tetanus and in general spasmodic 
disorders, but its efficacy is of questionable value. 

Contraindications. — The same as for conium. 

Administration. — The extract or the tincture is usually pre- 
ferred for internal administration, although the alkaloid fully repre- 
sents the drug and may be given either by the mouth or hypo- 
dermically. For application to the eye the salts of the alkaloid 
are used. A convenient form of physostigmine in ophthalmic 
practice is the medicated gelatin disks. 



Colchicum— Colchici— Colchicum. U. S. JP. 

(Meadow Saffron.) 

Origin. — The dried corm and seed of Colchicum autumnale, known respectively 
as Colchici cormus and Colchici seminis. A plant indigenous in Europe, in the 
southern and central portions of which it is frequently found in pastures and meadows, 
flowering in September or October, and ripening its seeds in June following. The 
corm and seeds are official. 

Description and Properties. — The corm is about i inch (25 Mm.) long, 
ovoid, flattish, with a groove on one side ; externally brownish and wrinkled, internally 
white and solid ; often in transverse slices, reniform in shape, and breaking with a 
short, mealy fracture ; inodorous ; taste sweetish bitter, and somewhat acrid. It should 
contain not less than 0.35 per cent, of colchicine. 

Dose. — 2-8 grains (0.12-05 Cm.) in powder [4 grains (0.250 Gm.), U. S. P.]. 

Colchicum seeds are subglobular, about ^ inch (2 Mm.) thick, very slightly 
pointed at the hilum ; reddish-brown, finely pitted, internally whitish; very hard and 
tough ; inodorous ; taste bitter and somewhat acrid. They should contain not less 
than 0.55 per cent, of colchicine 

Dose. — 1-5 grains (0.06-0.3 Cm.) [3 grains (0.2 Gm.), U. S. P.]. 

Both the corm (root) and seeds contain two alkaloid-like bodies, colchicine and 
colchiceine. These are closely related chemically. Colchiceine is said (Kionka) 
to be non-poisonous. 

Official Preparation. 

Colchicina — Colchicinae — Colchicine, U. S. P. — Definition, — An alkaloid, 
C 22 H 2r> N0 6 , obtained from colchicum. Although classed with the alkaloids, colchicine 
has an acid reaction. 

Character. — Pale-yellow leaflets or a pale-yellow amorphous powder, turning 
darker on exposure to light, having an odor suggesting damp hay, and a very bitter 
taste. 

Solubility. — SoluMe in water ( I : 22) and readily SO in alcohol. 



MISCELLANY. 579 

Incompatibility. — Colchicine is precipitated from solution by tannic acid. 
Dose. — Average dose: T ^ T grain (0.0005 Gm. = °-5 milligramme), U. S. P. 

Official Preparation of the Root. 

Extractum Colchici Cormi — Extracti Colchici Cormi — Extract of Colchicum 
Corm. — Dose, ]/ z -2 grains (0.03-0.12 Gm.). 

Official Preparations of the Seed. 

Fluidextractum Colchici Seminis — Fluidextracti Colchici Seminis — Fluid- 
extract of Colchicum Seed. — Dose, 1-5 minims (0.06-0.3 Cc), U. S. P. 

Tinctura Colchici Seminis — Tincturae Colchici Seminis — Tincture of Col- 
chicum Seed. — Dose, 10-30 minims (0.6-2.0 Cc). 

Vinum Colchici Seminis — Vini Colchici Seminis — Wine of Colchicum 
Seed. — Dose, 10-30 minims (0.6-2.0 Cc), U. S. P. 

Physiological Action. — Externally and Locally. — Colchicum is 
a decided local irritant, and when applied to the skin acts as a 
rubefacient. The dust when inhaled excites sneezing. 

Internally. — Digestive System. — In small medicinal doses colchi- 
cum slightly stimulates the salivary, gastric, biliary, and intestinal 
secretions. If these doses are repeated for several days, a sensa- 
tion of heat is experienced in the epigastrium, accompanied by loss 
of appetite and frequently by nausea. Full medicinal doses may 
produce purging and colic. Larger doses occasion profuse watery 
and choleriform or bloody evacuations from the bowels, severe 
abdominal pain and tenderness, excessive vomiting — in fact, all the 
symptoms produced by a violent gastro-intestinal irritant. 

Nervous System. — The nervous system is unaffected by medici- 
nal doses. Even when poisonous doses have been taken the 
intellect usually remains unimpaired, though Toulmouche has seen 
the drug induce marked cerebral excitement. Discordant state- 
ments have been made regarding the action of colchicum upon the 
nervous system. The drug evidently affects different persons dif- 
ferently. Thus, numbness or prickling, muscular pains or spasms, 
and occasionally convulsions, have been noticed ; yet the recent 
investigations of Houde-Laborde upon the action of colchicine 
show that it has no influence upon the centers of intelligence and 
volition, and does not induce paralysis of central origin, either 
motor or sensory, though the sensory nerves are considerably 
depressed. 

Circidatory System. — Full medicinal or larger doses produce 
great depression of the circulation, with a small, rapid, and thready 
pulse. The marked cardiac depression and collapse which occur 
when poisonous doses of colchicum have been taken are more the 
result of the severe gastro-enteritis than of any direct action upon 
the heart. 

Respiratory System. — Large or poisonous doses of colchicum 
render the respiratory movements slow and shallow. This action 
is not due to any direct effect upon the respiratory center — although 



580 A TEXT-BOOK OF MATERIA MEDICA. 

Rossbach and Wehmer maintain the contrary — but reflexly to the 
depression occasioned by the violent action of the drug upon the 
gastro-intestinal tract. 

Absorption and Elimination. — Colchicum is quite rapidly ab- 
sorbed, and is eliminated chiefly by the bowels and kidneys, the 
skin sharing to some extent in the excretory process. Some ob- 
servers allege that colchicum does not increase the amount of 
urine or the excretion of urea and uric acid, while others claim 
that these substances are increased. 

Temperature. — Under moderate medicinal doses the temperature 
is unaffected, though doses large enough to produce emeto-cathar- 
sis are followed by a reduction of temperature. 

Untoward Action. — Many symptoms described under Poison- 
ing, have been produced by very small doses. It is a matter of 
speculation whether these untoward manifestations were due to a 
decided idiosyncrasy on the part of the patient, or to the fact that 
the preparation employed might have contained an unusually large 
percentage of the alkaloid. Recent studies point to the fact that 
colchicine may be oxidized in the body to oxydicolchicine, which 
is the active poison. 

Poisoning. — The symptoms of poisoning by colchicum are vio- 
lent vomiting and purging, griping and intense pain in the abdomen, 
precordial distress, and at times excesssive salivation, sweating, or 
possibly convulsions. The initial symptoms may be delayed two 
or three hours or even more. A great sense of depression is char- 
acteristic. This is followed by weakness of the muscles, those of 
the extremities seem to be partly paralyzed. While death is for a 
time delayed under a poisonous dose, a fatal termination is usual 
(90 per cent.). The patient suffers excruciatingly, being little re- 
lieved by treatment, and dies of respiratory paralysis in twenty-four 
to forty-eight hours. The minimum lethal dose of colchicine is 
40 to 60 milligrams, up to 1 grain. 

Treatment of Poisoning. — All that can be done is to combat 
symptoms, giving opium for pain, oil and demulcent drinks for the 
irritation, and stimulants to counteract respiratory and cardiac 
depression. Washing out the stomach or the use of emetics may 
be required. Tannic acid serves as a partial antidote, precipitating 
the colchicine. 

Therapeutics. — Externally and Locally. — Colchicum has no 
local therapeutic action. 

Colchicum is valuable for gout in all its varied manifestations. 
Diarrhea, dysentery, dyspepsia, bronchitis, asthma, neuralgia, and 
eczema dependent upon a gouty condition are singularly benefited by 
colchicum. 

This medicine, while occasionally efficacious in chronic rheuma- 
tism, and occasionally of some benefit in rheumatoid arthritis, is of 
no value in acute articular rheumatism. 

Its value is more apparent in acute, than in chronic, gout, and in 
the first attacks than in succeeding ones. Chronic gout, as well as 



MISCELLANY. 581 

chronic rheumatism, yields better to a combination of colchicum 
and potassium iodide than to colchicum alone. 

In combination with certain other agents colchicum serves an 
excellent purpose as a cholagogue, full doses being frequently very 
effective in relieving ascites due to obstructive diseases of the liver. 
Salicylic acid or the salicylates are excellent adjuvants to colchicum 
in these conditions. 

Colchicum is sometimes employed as a drastic purgative in 
cerebral and portal congestion, although when given in doses suf- 
ficient for this purpose it occasions considerable nausea and abdom- 
inal distress. It is unsafe in this connection. 

Contraindications. — The drug would be contraindicated in 
acute inflammatory conditions of the gastro-intestinal tract. It 
should be cautiously administered to old people. 

Administration. — The liquid preparations are to be preferred, 
and, in order to secure the full curative effects of the drug, it is 
unnecessary to give it in doses sufficiently large to cause nausea. 
The initial dose, therefore, should be small, that it may occasion no 
gastric disturbance. 

The beneficial effects of colchicum may be enhanced by first 
emptying the intestinal canal by means of a saline cathartic. 

Sarsaparilla— Sarsapariliae— Sarsaparilla. TI. $. J>. 

Origin. — The dried root of Smilax medica Chamisso and Schlechtendal, Smilax 
ornata Hooker, Smilax papyracea Duhamel, or a dried root known commercially as 
Honduras Sarsaparilla, which is probably obtained from Smilax officinalis Kunth. 

The species of smilax grow in swampy forests in Mexico and as far south as the 
northern portion of Brazil. 1 hey are woody climbers, often attaining a great height. 

Description and Properties.— About % to X inch (3.1 7-6.35 Mm.) thick, 
very long, cylindrical, longitudinally wrinkled, externally grayish- or orange-brown; 
internally 'showing a whitish and mealy or somewhat horny cortical layer surrounding 
a circular wood-zone enclosing a broad pith ; nearly inodorous ; taste mucilaginous, 
bitterish, and acrid. The thick, woody, knotty rhizome, if present, should be removed. 

Sarsaparilla contains an active principle, parillin, an acrid glycoside which froths 
with water and otherwise closely resembles saponin in its action; it also contains sapo- 
nin and sarsa-saponin, two glycosides, the latter of which is the most poisonous glyco- 
side in the plant. 

Dose.— 30-60 grains (2.0-4.0 Gm.) [30 grains (2 Gm.), U. S. P.]. 

Official Preparations. 

Fluidextractum Sarsaparillse— Fluidextracti Sarsapariliae— Fluidextract of 
Sarsaparilla.— £W, %-z fluidrams (2.0-8.0 Cc. ) [30 minims (2 Cc), U. S. P.]. 

Fluidextractum Sarsapariliae Compositum— Fluidextracti Sarsapariliae 
Compositi— Compound Fluidextract of Sarsaparilla.— Dose, %-2 fluidrams (2.0- 
8.0 Cc.) [30 minims (2 Cc), U. S. P.]. 

Syrupus Sarsapariliae Compositus— Syrupi Sarsapariliae Compositi— Com- 
pound Syrup of Sarsaparilla.— A fluidextract, 20 per cent., with the fluidextracts 
of glycyrrhiza and senna, and the oils of sassafras, anise, and gaultheria. 

Dose.— 2-4 fluidrams (8.0-16.0 Cc.) [4 fluidrams (16 Cc), U S. P.]. 

Physiological Action. — Sarsaparilla has no local influence. 
Internally its action is due to the saponins contained. These have 
been discussed elsewhere. 

Therapeutics. — As with guaiac, the history of sarsaparilla is 



582 A TEXT-BOOK OF MATERIA MEDICA. 

full of interest. Introduced into Europe in the sixteenth century 
by the Spaniards, who had learned of its alleged virtues in consti- 
tutional syphilis in Peru, San Domingo, and Brazil, it retained its 
reputation as a specific in this disease for a century or more, when 
it was abandoned, only to be revived at the close of the eighteenth 
century. Since that time it has retained its place in medicine more 
through the wonderful virtues ascribed to it by nostrum-venders 
than to any real medicinal properties which it possesses. 

The consensus of competent opinion seems to be that sarsa- 
parilla can claim no special medicinal virtues other than its diuretic 
and diaphoretic properties. 

Contraindications. — There are none. 

Administration. — No special directions can be given for the 
administration of the various preparations. The compound syrup 
of sarsaparilla is quite pleasant to the taste, and is used extensively 
as a vehicle, particularly for potassium iodide. The sarsaparilla of 
the soda-water fountain is a mixture of aromatics, principally sassa- 
fras and wintergreen. It has no relation to sarsaparilla. 

Stillingia— Stilling-iae— Stillingia. U. S. JP. 

(Queen's Root.) 

Origin. — The dried root of Stillingia sylvatica L., a perennial herb growing in 
dry and sandy soil in the Southern United States as far north as Eastern Virginia. 

Description and Properties. — About i foot (30 Cm.) long and nearly 2 
inches (5 Cm.) thick, subcylindrical, slightly branched, compact, wrinkled, tough, 
grayish-brown, breaking with a fibrous fracture, showing a thick bark and porous 
wood, inner bark and medullary rays having numerous yellowish-brown resin-cells. 
The odor is peculiar and unpleasant ; the taste bitter, acrid, and pungent. 

It contains an acrid resin, sylvacrol, a volatile and a fixed oil, starch, gum, tannin, 
and a glycoside. 

Dose. — 15-30 grains (1.0-2.0 Gm. ). 

Official Preparation. 

Fluidextractum Stilhngise— Fluidextracti Stillingiae— Fluidextract of Stil- 
lingia.— Dose, %-\ fluidram (1.0-4.0 Cc.) [30 minims (2 Cc), U. S. P.]. 

Physiological Action. — The action of stillingia resembles that 
of sarsaparilla, the drug increasing the various secretions and stim- 
ulating the heart and circulation. 

Guaiacum— Guaiaci— Guaiac. TJ. S. P. 

Origin. — The resin of the wood of Guaiacum officinale L., or of Guaiacum 
sanctum L. 

Description and Properties. — Irregular masses or subglobular pieces, 
externally greenish-brown, internally of a glassy luster, and in recent guaiac usually 
reddish-brown, transparent in thin splinters, fusible, feebly aromatic, the odor becom- 
ing stronger upon heating; taste somewhat acrid ; powder grayish, turning green on 
exposure to air. Soluble in potassium or sodium hydrate T. S. and in alcohol, the 
alcoholic solution being colored blue by the addition of tincture of ferric chloride. 

The principal constituents of guaiac resin are — guaiaconic acid, guaiacic acid, 
guaiaretic acid, and a small amount of gum. It also contains volatile oils. These 
substances are insoluble in water, but soluble in alkalies. 

Dose.— 5-30 grains (0.3-2.0 Gm.) [15 grains (1 Gm.), U. S. P.]. 



MISCELLANY. 583 

Official Preparations. 

Tinctura Guaiaci— Tincturae Guaiaci— Tincture of Guaiac. — Dose, 30-60 
minims (2.0-4.0 Cc.) [1 fluidram (4 Cc), U. S. P.]. 

Tinctura Guaiaci Ammoniata — Tincturae Guaiaci Ammoniatse — Ammo- 
niated Tincture of Guaiac. — Dose, 30-60 minims (2.0-4.0 Cc.) [20 minims (2 Cc.}. 
U. S. P.]. y V ' 

Physiological Action. — Externally and Locally. — Guaiac is 
antiseptic, and possesses mildly astringent properties, being used 
locally as a gargle. 

Internally. — Guaiac belongs to the volatile-oil group and is to 
be classed there. For many years it has been considered useful as 
an alterative, being given with sarsaparilla in the treatment of syph- 
ilis. It is highly doubtful if it has any specific action. 

Therapeutics. — Externally and Locally. — Guaiac in some form 
is an excellent application in folliadar tonsillitis, rheumatic pharyn- 
gitis, and quinsy. For these cases the emulsion of guaiac serves 
as an efficient gargle, or the troches of guaiac may be used. 

Internally. — From the sixteenth to the eighteenth century 
guaiac was renowned as a cure for syphilis, having been introduced 
into Europe from San Domingo. The heroic manner, however, in 
which the drug was employed rendered the results more injurious 
than beneficial, so that the guaiac treatment was condemned, one of 
its most vigorous opponents being Paracelsus, to whom the reintro- 
duction of mercury for the treatment of syphilis is largely due. The 
drug possesses properties which render it valuable in chronic mus- 
cular rheumatism, neuralgic dysmenorrhea, and atonic amenorrhea. 

Guaiac is considered to be an efficient remedy in lumbago and 
chronic gout. Its most important service, however, in therapeutics 
is in the treatment of quinsy. It is doubtful whether there is any 
drug which will modify the course of this disease or abort an 
attack of tonsillitis so readily as this medicine. The tincture of 
guaiac is the preparation usually employed for this purpose, J 
fluidrachm (2.0 Cc.) being given in the form of an emulsion every 
three or four hours. 

Contraindications. — There are no marked contraindications to 
its use. 

Administration. — The tinctures are very acrid and disagreeable 
to the taste, and should be given in the form of an emulsion. The 
emulsion of guaiac, a formula for which is given in the Dispensatories, 
is not unpleasant, and is altogether the best liquid preparation to give. 

The lozenges of guaiac, allowed to dissolve slowly in the mouth, 
serve as an agreeable and efficient method of medicating the throat 
with this drug. 

Viburnum Prunifolium— Viburni Prunifolii— Black 

Haw. U. S. JP. 

Origin. — The dried bark of Viburnum prunifolium L., a tall shrub or small tree 
10 to 20 feet (3-6 M.) high, growing in thickets throughout the greater portion of the 
United States east of the Mississippi. 



584 A TEXT-BOOK OF MATERIA MEDIC A. 

Description and Properties.— Thin pieces or quills, glassy purplish-brown, 
with scattered warts and minute black dots ; when collected from old wood, grayish- 
brown, the thin corky layer easily removed from the green layer ; inner surface whitish, 
smooth ; fracture short ; inodorous ; somewhat astringent and bitter. 

It contains a bitter principle (viburnin), a bitter resin, valerianic acid, besides 
tannic, oxalic, citric, and malic acids. 

Dose. — 30-60 grains (2.0-4.0 Gm.) [30 grains (2 Gm.), U. S. P.]. 

Official Preparation. 

Fluidextractum Viburni Prunifolii — Fluidextracti Viburni Prunifolii — 
Fluidextract of Black Haw. — Dose, y 2 -\ fiuidram (1.8-3.7 Cc.j. 

Physiological Action and Therapeutics. — The action of black 
haw is best understood by classing it with the volatile-oil group. 
It acts as an antispasmodic, diuretic, nervine, and tonic, being espe- 
cially useful in various uterine disorders, such as spasmodic and 
membranous dysmenorrhea. 

The various vasomotor disturbances and the menorrhagia inci- 
dent to the menopause are frequently relieved by this remedy. It 
is also of some value in the prevention of abortion. Its sedative 
properties render it serviceable in relieving the severity of after- 
pains. 

Viburnum Opulus— Viburni Opuli— Cramp Bark. 

U. S. JP. 

Origin. — The dried bark of Viburnum opulus L., a small tree 10 to 15 feet (3- 
4.5 M. ) high, indigenous in Canada, the Northern United States, Europe, and North- 
ern Asia. 

Description and Properties. — Flattish or curved bands, or, occasionally, 
quills, sometimes 12 inches (30 Cm.) long and from ^V to -^ inch ( I— 1 . 5 Mm.) thick; 
outer surface ash-gray, marked with somewhat transversely scattered, elongated warts 
of a brownish color, due to abrasion, and marked more or less with blackish dots, 
with black, irregular lines or thin ridges, arranged chiefly in a longitudinal direction ; 
underneath the easily removed corky layer of a pale-brownish or reddish-brown color ; 
the inner surface dingy white or brownish ; fracture tough, the tissue separating in 
layers ; inodorous ; taste somewhat astringent and bitter. 

Dose.— 1-2 drams (4.0-8.0 Gm.) [30 grains (2 Gm.), U. S. P.]. 

Official Preparation. 

Fluidextractum Viburni Opuli — Fluidextracti Viburni Opuli — Fluidextract 
of Cramp Bark. — Dose, 1-2 fluidrams (3.7-7.3 Cc). 

The general observations upon Viburnum prunifolium are appli- 
cable to this drug. 

Sumbul— Sumbul— Sumbul. U. 8. P. 

Origin. — The dried root of an undetermined plant, probably of the family Umbel' 
lifercE. It is thought by some to be Ferula sumbul (Kauffmann) Hooker fil, a peren- 
nial about 8 feet (2.4 M. ) high, indigenous in regions north and east of British India. 

Description and Properties. — It occurs in transverse segments, varying in 
diameter from I to 3 inches (2-7 Cm.), and in length from 6 to 12 inches f 14-30 
Cm.); light spongy, annulate or longitudinally wrinkled ; baric thin, brown, more or 
less bristly fibrous; the interior whitish, with numerous brownish-yellow resin-dots 



MISCELLANY. 585 

and irregular, easily separated fibers ; odor strong, musk-like ; taste bitter and bal- 
samic. It contains sumbolic and valerianic acids, a small quantity of volatile oil, and 
two balsamic resins to which its odor is due. 

Dose.— 15-30 grains (1.0-2.0 Gm.) [30 grains (2 Gm.), U. S. P.]. 

Official Preparations. 

Fluidextractum Sumbul — Fluidextracti Sumbul — Fluidextract of Sumbul. 
Dose, average dose : 30 minims (2 Cc. ). 

Extractum Sumbul — Extracti Sumbul— Extract of Sumbul. — Prepared from 
the fluidextract of sumbul. 

Dose. — Average dose : 4 grains (0.250 Gm. =250 milligrammes. 

Physiological Action. — See Volatile-oil Group (Valerian). 

Therapeutics. — The drug is valuable in the various manifesta- 
tions of hysteria, and has been employed with some success in 
ovarian neuralgia and dysmenorrhea. 

It is similar to, though not so efficient as, grindelia in spasmodic 
coughs. Indeed, most of the disorders benefited by the antispas- 
modics yield to the influence of sumbul. 

In neurasthenia with anemia the extract of sumbul, combined 
with iron and arsenic, serves a very useful purpose. 

Benzosulphinidum— Benzosulphinidi— Benzosul- 
phinide. U. S. P. 

( Saccharin.) 

Definition. — An anhydride of orthosulphamide benzoic acid, C 6 H 4 S0 2 .CO.NH. 
It is variously known as glucosimide, saccharol, saccharinol, saccharinose, agucarine, 
etc. 

Description and Properties. — Its derivation from toluol (from which it is 
usually made) is shown by the following formulas : 

C 6 H 5 CH 3 ^ C 6 H 4 <^ 2 y)-^ C 6 H 4 <S0 2 NH w 

Toluol. o-Toluolsulphonic-acid, o-Toluolsulphamide. 

C « H < <COOH 2 — C e H <<CO> NH 

o-sulphamide-benzoic Anhydride of o-sulph- 

acid. amide-benzoic acid 

(Saccharin). 

Saccharin was discovered in 1879 by Ira Remsen and C. Fahlberg. It is a white, 
crystalline powder, nearly odorless, having an intensely sweet taste even in dilute solu- 
tions. The sweet taste may be recognized in a dilution of I : 100,000, as compared 
with cane-sugar, I : 200. Soluble in 250 parts of water and in 25 parts of alcohol ; 
more so in boiling water (1 : 24). It behaves like a strong acid and dissolves readily 

CO 
in alkalies ; the sodium salt (C 6 H 4 <^o^ ^>NNa) is known as soluble saccharin or 

crystallose. 

The Liquor Saccharini of the National Formulary is a solution of saccharin in 

sodium bicarbonate and alcohol. There are a number of preparations on the market, 

such as antidiabetin, which contain saccharin (Hunt). 

Dose. — Average dose: 3 grains (0.200 Gm. = 200 milligrammes. (U. S. P.) 
Dulcin or zucrol, another very sweet substance, is para-phenetolcarbamid ; saxin 

is a similar product. 



586 A TEXT-BOOK OF MATERIA MEDICA. 

Physiological Action. — In a neutral or alkaline medium, sac- 
charin acts as an antiseptic. Internally it exerts no notable influ- 
ence. It is said that when mixed with food it interferes with the 
action of saliva upon starch, and it is thought to retard the action 
of the other digestive ferments. The drug is not decomposed in 
the body, and is eliminated by the kidneys unchanged, increasing 
the amount of chlorides excreted in the urine, which fluid is so 
influenced by the drug that it does not so readily undergo fer- 
mentation. 

Therapeutics. — Externally and Locally. — Saccharin is used as 
a mouth-wash, being especially beneficial in aphtha. Felici, of 
Rome, highly recommends the application of a solution of saccharin 
in ozena. 

Internally. — The principal use of the drug is as a substitute for 
sugar in cases of diabetes. It is sometimes useful as an antiseptic 
in cystitis. It also acts as benzoic acid in limiting intestinal putre- 
faction as well. 

The drug is extensively used in various elixirs, syrups, etc., to 
overcome the bitterness of quinine and other bitter alkaloids. 

Administration. — Saccharin should be given in solution, or in 
tablets which may be dissolved singly in a cup of coffee. 

Peabody recommends the following formulae : 

R. Saccharin, io.o; 

Sodium carbonate, u.o; 

Aquse, q. s. ioo.o. 

Dose for tea, coffee, etc., to be determined by experiment. 

R. Saccharin, 45 grains; 

Sodium carbonate, 30 grains ; 

Mannite, 10 ounces. 

Divide in 100 equal parts and use as lump sugar for sweetening purposes. 

Methylthioninae Hydrochloridum— Methylthioninae 
Hydrochloridi— Methylthionine Hydrochloride. 
U. S. JP. 

(Methylene Blue.) 

Chemically, it is tetramethylthionine hydrochloride. 

Properties. — Dark-green, crystalline powder, or prismatic crystals having a 
bronze-like luster. Readily soluble in water, somewhat less so in alcohol ; the solu- 
tions are of a deep-blue color. Incompatible with potassium iodide. Reducing agents 
decolorize it. It is not to be confounded with commercial methylene blue, which is 
often the zinc chloride double salt of tetramethylthionine, is employed as a dye or 
stain, and is unfit for internal administration. 

Dose. — Average dose : 4 grains 0.250 Gm. = 250 milligrammes, U. S. P. 

Therapeutics. — It is an intercellular antiseptic, useful in de- 
stroying the malarial parasite. It is also of value in genito-urinary 
practice. 



TOPICAL REMEDIES. 



Rubefacients, Vesicants, and Escharotics. — These consist 
of a series of remedies that act directly upon the skin or mucous 
membrane, and are known by different names, according to the 
amount of irritation produced. Rubefacients, as the mildest, 
cause a redness of the skin with dilated blood-vessels ; if their 
action is continued, local extravasation of serum beneath the epi- 
dermis may take place, forming a blister. If their action is more 
severe or if long continued, death of tissue may take place, thus 
causing a cauterizant action with the formation of an eschar. 
Emollients and demulcents have an opposite effect, in that they 
tend to allay or prevent irritative reactions on the part of the skin 
(emollients) or mucous membranes (demulcents). 

RUBEFACIENTS. 

These are drugs which, when locally applied, are intended to 
produce temporary redness and congestion of the skin. Some 
of them are vesicant if applied in full strength, and, if their contact 
with the skin be sufficiently prolonged, pustulation, or even total 
destruction of tissue, may result. 

The following list embraces the principal rubefacient drugs : 

Ammonia, Menthol, 

Alcohol, Mezereon, 

Arnica, Mustard, 

Camphor, Oil of cajuput, 

Capsicum, Oil of turpentine, 

Chloroform, Pitch, 

Ether, Volatile oils. 
Iodine, 

Hot water and friction are also rubefacient agents. 

Rubefacients are used for their influence upon the skin itself or 
for their effect on deep-seated structures. 

Rubefacients are efficient means of relieving neuralgic pains, 
conditions of nervous debility, nervous excitement, the sense of 
fatigue, and as aids in narcotic poisoning, also to hasten the absorp- 
tion of inflammatory exudates, to remove the swelling and restore 
the function of chronically inflamed joints, etc. 

Rubefacients should ordinarily be applied with friction, as rub- 
bing of the skin aids the action of many of them. 

Save one, all the rubefacients mentioned in the preceding list 
have been considered elsewhere in the present work. 

587 



588 A TEXT-BOOK OF MATERIA MEDICA. 

Mezereum— Mezerei— Mezereum, U. S. J\ 

Definition. — The dried bark of Daphne mezereum L., and of other European 
species of Daphne. 

Description and Properties. — Long, thin bands, usually folded or rolled 
into disks, the outer surface yellowish or brownish yellow, with transverse scars and 
minute blackish dots, underneath of a light-greenish color; inner surface whitish, silky. 
Bast in transverse layers, very tough ; inodorous ; taste very 7 acrid. The important 
constituent is an acrid resin, mezerein ; an acrid oil resembling crotonoleic acid has 
been described. 

Dose. — 1-5 grains (0.06-0.3 Gm. ) [7 \ grains (0.5 Gm.), U. S. P.]. 

Official Preparation. 

Fluidextractum Mezerei — Fluidextracti Mezerei — Fluidextract of Meze- 
reum. — Dose, 1-5 minims (0.06—0.3 Cc). Mezereum is also one of the ingredients in 
Decoctum Sarsaparillae Compositum, Extractum Sarsaparillae Fluidum Compositum, 
and Linimentum Sinapis Compositum. 

Physiological Action. — Its action, both locally and internally, 
is quite similar to that of sanguinaria, but when applied to the 
skin it is more of a vesicant than an escharotic, and taken inter- 
nally it is more of a diuretic than sanguinaria, in poisonous doses 
causing severe urinary irritation and other symptoms produced by 
a violent gastro-intestinal irritant. The treatment of poisoning 
would be the same as that prescribed under poisoning by sangui- 
naria. 

Therapeutics. — It is a counterirritant in the form of an oint- 
ment. Internally it is now seldom, if ever, used alone, but in com- 
bination with other vegetable specifics it is prescribed in chronic 
rheumatism and in chronic syphilitic, and non-syphilitic, cutaneous 
diseases. 

Contraindications. — Acute inflammation of the stomach, bow- 
els, and kidneys. 

Administration. — As it is never given internally alone, no spe- 
cial instructions for its administration are necessary. The fluid 
extract freely diluted with water would, however, be the only 
preparation to use. 



Xanthoxylum— Xanthoxyli— Xanthoxylum. V. S. P. 

(Prickly Ash.) 

Origin. — The dried bark of Xanthoxylum Americanum Miller or of Fagara 
Clava- Her cutis (L. ) Small. Both species are native to North America, the first being 
shrubby and attaining a height of 10 or 12 feet (3-3.6 M.), while the second species 
is a >mall tree sometimes 30 or 40 feet (9-12 M. ) high. 

Description and Properties. — Xanthoxylum Americanum f Northern 

Ash) occurs in curved or quilled fragments about fa inch (I Mm.) thick; 

-urface brownish gray, with whitish patches and minute black dots, slightly 

■ '], with some brown, glossy, straight, two-edged -pines, linear at the base and 

about ! 4 inch (6 Mm. long ; inner surface whitish, smooth : fracture short, non-fibrous, 

green in the outer, and yellowish in the inner, layer; inodorous; taste bitterish, very 

-.'.' Southern Prickly Ash) resembles the preceding, 

but is about ^ inch (2 Mm.) thick, and is marked by many conical, corky projections, 

sometimes i inch 1 2 ( m ) high, and by stout, brown spines rising from a corky base. 



TOPICAL REMEDIES. 589 

Xanthoxylum should not be confounded with the bark of Aralia spinosa L., which 
is nearly smooth externally, and beset with slender prickles in transverse rows. 

Prickly ash contains an acrid green oil, a colorless, crystalline resin, a bitter prin- 
ciple, sugar, ash, and tannic acid. 

Dose. — 10-30 grains (0.6-2.0 Gm. ) [30 grains (2 Gm.), U. S. P.]. 

Official Preparatiofi. 

Fluidextractum Xanthoxyh — Fluidextracti Xanthoxyli — Fluidextract of 
Xanthoxylum. — Dose, io-30-minims (0.6-2.0 Cc.) [30 minims (2 Cc. ), U. S. P.]. 

Physiological Action. — The action of xanthoxylum is quite 
similar to that of mezereum, though it is more of a stomachic 
tonic, sialagogue, diuretic, and diaphoretic, and not so much of a 
local irritant. It increases the heart's action and raises arterial 
tension. 

Therapeutics. — It is used locally as a masticatory for the same 
purpose as mezereum, and the decoction has been highly recom- 
mended as a gargle in clironic pJiary?igitis. Internally it has no 
useful applications. 

CAUSTICS OR ESCHAROTICS, 

Caustics are medicines which destroy the tissues to which they 
are applied. They excite inflammation and vascular dilatation of 
the surrounding area. The eschar produced by these drugs is 
separated from the living tissues by the inflammation and suppura- 
tion produced. 

The action of caustics is typically a chemical or physicochemical 
one. The layer of cells that may be destroyed varies in depth 
with the caustic employed, and the caustic used may cause a hard, 
smear-like, or fluid eschar, which, by demarcating inflammatory 
processes, is sooner or later thrown off. The caustics may be 
divided roughly into caustic acids, caustic alkalies, caustic metallic 
salts, and some few organic caustic compounds not readily classi- 
fied. In many of the acids and salts the action of the acid ion of 
the caustic causes oxidation and reducing processes. By many of 
the acids an acid albumin or syntonin is formed ; by the alkalies, an 
alkali albuminate ; and by the salts, metal albuminates are pro- 
duced. Many of these metal albuminates are permanent, in which 
case a characteristic hard and scaly eschar results. 

The character of the eschar is determined largely by the tissue 
involved : thus, by alkaline caustics, the keratin of the skin is dis- 
solved ; fatty substances are converted into soaps or soapy masses. 
Many caustics have the power of being absorbed and of causing 
systemic poisoning. The salts of chromium, osmium, and arsenic 
are of importance in this connection. 

Many of the caustics cause extreme pain, and their use is gradu- 
ally being abandoned for the more accurate methods of surgery. 

Caustics are employed for the following general purposes : 

I. In specific acute poisonous injuries, as from the bite of poison- 



590 A TEXT-BOOK OF MA TERIA MEDICA. 

ous insects, reptiles, or other animals. The caustic is applied to 
the wound directly, in order to destroy the poison. Permanganate 
of potash, alkalies, or the direct cautery are the most reliable. 

2. To destroy new growths of microbial origin. In lupus, sar- 
coma, carcinoma, chancres, charbon, etc., nitric acid, alkalies, glacial 
acetic acid, etc. are most employed. 

3. To remove small tumors, warts, polypi (nasal or genital), 
hypertrophied mucous membranes. Here nitric and chromic acids, 
silver nitrate, etc., are of service. 

4. For depilatory purposes — removing hair, etc. 

5. To reduce and destroy inoperable tumors. Here the more 
caustic alkalies, arsenic, zinc, etc., have been widely employed in 
the past. 

6. To reduce flabby and exuberant granulations in wounds. 
Nitrate of silver is one of the best drugs. 

7. At times to influence deeper parts, in neuralgias and inflam- 
matory action in an internal organ, it is beneficial to employ a 
superficial escharotic. 

Those escharotics which have not been discussed elsewhere 
will here be considered in detail : 

Chromii Trioxidum— Chromii Trioxidi— Chromic 
Trioxide. U. S. P. 

(Chromic Anhydride; Chromic Acid. U. S. P.) 

Origin. — Dissolve potassium bichromate in sulphuric acid and water ; decant ; 
heat with more sulphuric acid ; cool, and crystallize. 

Description and Properties.— Small, needle-shaped crystals or rhombic 
prisms, of a dark purplish-red color and metallic luster ; odorless ; destructive of 
animal and vegetable tissues ; deliquescent in moist air. Very soluble in water, form- 
ing an orange-red solution. When brought in contact with alcohol, ether, glycerin, 
and other organic solvents decomposition takes place, sometimes with dangerous 
violence. Chromium trioxide should be kept in glass- stoppered bottles, and great caution 
should be observed to avoid bringing it in contact with organic substances, such as 
cork, tannic acid, sugar, alcohol, etc., as dangerous accidents are liable to result. Used 
externally. 

Physiological Action and Therapeutics. — Chromium trioxide 
is a powerful caustic, deodorant, and disinfectant. It coagulates 
albumin and oxidizes organic matter. Its action is slow, and the 
pain following its application is usually of shorter duration than 
that of most caustics. Weak solutions are stimulant, astringent, 
and alterative. 

Chromic acid is used in the form of a paste or in solutions of 
various strengths for the removal of syphilitic warts, vegetations, 
condylomata, etc. As a caustic and stimulant application in many 
diseases of ear, nose, and throat it serves a valuable purpose, as in 
nasal polypi, enlarged tonsils, chronic and syphilitic laryngitis, laryn- 
geal papillomata, chronic superficial glossitis, tuberculosis of the 
tongue, ozena, ulcerations of the mouth, etc. 

A 10 per cent, solution of chromic acid has been found service- 
able in the treatment of hyperidrosis. 



TOPICAL REMEDIES. 591 

A solution of 1 part of chromic acid in 40 parts of water makes 
an efficient lotion for disinfecting foul ulcers and as an injection in 
gonorrhea, leucorrhea, etc. 

Sessile piles and salivary fistulce are efficiently treated by touch- 
ing the parts with pure chromic acid. 

Potassii Hydroxidum— Potassii Hydroxidi— Potas- 
sium Hydroxide. U. S. I*. 

(Potassium Hydroxide; Caustic Potash; Potassa. U. S. P., 1890.) 

Origin. — Prepared by evaporating liquor potassse, fusing the residue, and pouring 
into clean cylindrical molds which have been previously warmed. 

Description and Properties. — Dry, white, translucent pencils, or fused 
masses, hard and brittle, showing a crystalline fracture ; odorless or having a faint 
odor of lye, and of a very acrid and caustic taste. Because of its active effect upon 
organic tissues it should be tasted and handled with exceeding care. Exposed to the 
air, it rapidly absorbs carbon dioxide and moisture, and deliquesces. Soluble in about 
0.4 part of water and in 2 parts of alcohol. Potassa should be kept in well-stoppered 
buttles made of hard glass. Used externally. 

Sodii Hydroxidum— Sodii Hydroxidi— Sodium 
Hydroxide. U. S. P. 

(Caustic Soda; Soda. U. S. P., 1890.) 

Origin. — Prepared from a solution of soda in the same manner as described under 
Potassii Hydroxidum. 

Description and Properties. — Dry, white, translucent pencils or fused 
masses, showing a crystalline fracture, odorless, and having an acrid and caustic taste. 
Great caution is necessary in tasting and handling it, as it rapidly destroys organic 
tissues. Exposed to the air, it rapidly deliquesces, absorbs carbon dioxide, and becomes 
covered with a dry coating of carbonate. Soluble in I part of water, very soluble in 
alcohol. Soda should be kept in well- stoppered bottles made of hard glass. Used 
externally. 

Physiological Action and Therapeutics. — Potassii hydrox- 
idum is one of the strongest and most penetrating caustics known. 
It possesses the property of abstracting water from the tissues, 
neutralizing free acids, decomposing nitrogenous compounds, and 
of forming solutions of fibrin, albumin, and gelatin. 

When applied to the soft tissues it occasions severe pain, and 
produces a moist, ashen, and then black, leathery slough, which 
leaves a granulating ulcer behind it. 

When potassium hydroxide is taken internally in immoderate 
doses it produces- all the symptoms of corrosive poisoning. Small 
doses, freely diluted, have the same action as the alkalies. 

As a caustic, potassa is used for the same purposes as the caus- 
tics previously described. 

The action and therapeutics of sodium hydroxide are identi- 
cal with those of potassa, save that soda is less depressing to the 
heart, muscular and nervous systems. It is not used so much as 
potassa, the latter preparation usually being preferred as a caustic. 

To limit the caustic action of these drugs a piece of adhesive 
plaster should be applied first, with an aperture of the size desired. 



592 A TEXT-BOOK OF MA TERIA MEDICA. 

Upon the skin exposed in the hole in the plaster the caustic is 
placed, the skin having been previously moistened. The caustic 
action may be arrested at any time by wetting the part with vinegar. 

Acidum Aceticum Glaciale— Acidi Acetici Glacialis 
—Glacial Acetic Acid. V. S. JP. 

Origin.— Prepared by distilling dry sodium acetate with strong sulphuric acid. 

Description and Properties.— A clear, colorless liquid, oi a strong, vine- 
gar-like odor, and a very pungent, purely acid taste. Its specific gravity at 25 Cc. (77 
F.) should not be higher than 1.049, corresponding to at least 99 per cent, of absolute 
acid. 

Used externally. 

Physiological Action and Therapeutics. — Glacial acetic acid is 
a powerful corrosive poison, having an action similar to that of the 
mineral acids. The drug is principally used as a caustic for the 
removal of warts and corns, and occasionally for blistering the skin. 

Acidum Trichloraceticum— Acidi Trichloracetic!— 
Trichloracetic Acid. V. S. JP. 

Definition. — A monobasic organic acid, CCl 3 .COOH, usually obtained by the 
oxidation of hydrated chloral with nitric acid. 

Description and Properties. — White, deliquescent, rhombohedral crystals, 
having a slight, characteristic, mildly pungent odor. Very soluble in water and alcohol ; 
in the latter, part of the acid is changed into the ester. The aqueous solution on boiling 
is decomposed with the formation of chloroform and carbon dioxide : CG 3 COOH = 
CHCI3 + C0 2 . 

10 parts of trichloracetic acid and I part of water form a liquid known as acidum 
trichloraceticum liquefactum ; it is often dispensed in this form. (See Phenol Lique- 
facttitn'). 

It precipitates proteids and is used as a reagent for the detection of albumin in 
urine and milk. 

Trichloracetic acid is far stronger than acetic acid and should be used with great 
caution. 

Calx— Calcis— Lime. V. 8. P. 

Origin. — Obtained by burning white marble, oyster shells, or the purest varieties 
of natural calcium carbonate. 

Description and Properties. — Hard, white or grayish-white masses, which, 
in contact with air, gradually attract moisture and carbon dioxide, and fall to a white 
powder ; odorless ; of a sharp, caustic taste. Soluble in about 760 parts of water, 
insoluble in alcohol. 

Used externally. 

Physiological Action and Therapeutics. — Quicklime when 
used undiluted is caustic, producing effects similar to those de- 
scribed under Potassa. 

For caustic purposes it is usually mixed with potassa (potassa 
cum calce). When lime is given in diluted solution it acts as an 
astringent and antacid. (See Liquor Calcis.) 

The conditions for which lime is employed as a caustic are men- 
tioned under Potassa. 



TOPICAL REMEDIES. 593 

Zinci Chloridum— Zinci Chloridi— Zinc Chloride. 

V. S. .P. 

Origin.— Prepared by dissolving zinc in boiling hydrochloric acid. To the solu- 
tion is added first nitric acid, then zinc carbonate to precipiiate the impurities. Filter 
and finally evaporate. 

Description and Properties. — A white, granular powder or porcelain-like 
masses, irregular or molded into pencils; odorless; of such intensely caustic proper- 
ties as to make tasting dangerous, unless the salt is dissolved in much water, when it 
has an astringent, metallic taste. Very deliquescent; soluble in about 04 part of 
water, forming a clear solution ; very soluble in alcohol. Zinc chloride should be kept 
in small, glass-stoppered bottles. 

Used externally. 

Official Preparation. 

Liquor Zinci Chloridi -Liquoris Zinci Chloridi— Solution of Zinc Chloride 
(U. S. F.).— Used externally. 

Physiological Action and Therapeutics. — Zinc chloride is 
caustic, antiseptic, disinfectant, irritant, astringent, and slightly 
hemostatic, according to the strength of the preparation. Its caus- 
tic action is painful, yet, while the drug penetrates very deeply, 
limited to the seat of application. 

Poisoning by zinc chloride is evidenced by all the symptoms 
produced by a violent corrosive irritant poison. 

The drug formerly enjoyed quite a reputation as a remedy for 
cancer, especially epithelioma, in which case it was used in the form 
of " caustic arrows " inserted in the base of the growth so as to 
separate it from the healthy tissues. 

It is used as a paste and lotion for morbid grozvths, lupus exe- 
dens, putrid ulcers, ncevi, and syphilitic sores. 

Solutions of zinc chloride are injected into polypi and scrofu- 
lous glands, and for the destruction of the pulp of decayed teeth. 

A weak solution of zinc chloride is an efficient injection in 
gonorrhea, leucorrhea, and hemorrhagic endometritis. 

For caustic purposes the zinc chloride itself may be used, or 
a paste prepared with starch, gypsum, flour, anhydrous sulphate 
of lime, or powdered althea. Mayet's paste consists of zinc chlo- 
ride 8 parts, zinc oxide I part, dried wheat flour 7 parts, and water 
I part. The cuticle must always be removed before applying the 
paste, strong water of ammonia answering for this purpose. 



Bromum— Bromi— Bromine. U. S. JP. 

Origin. — It is found both in seawater and in saline springs, but is chiefly obtained 
from the mother-liquors of salt-works in the United States and at Strassfurth, Germany. 

Description and Properties. — A heavy, dark brownish-red, mobile liquid, 
evolving, even at ordinary temperatures, a yellowish-red vapor, highly irritating to the 
eyes and lungs, and having a peculiar suffocating odor, resembling that of chlorine. 
Soluble in 28 parts of water and readily soluble in alcohol or ether. Bromine should 
be kept in glass-stoppered bottles, in a cool place. 

Used externally. 



594 



A TEXT-BOOK OF MATERIA MEDICA. 



Physiological Action and Therapeutics. — Bromine is a power- 
ful corrosive irritant, the fumes of which occasion severe irritation 
of the eyes and respiratory passages, with cough, hoarseness, and 
dyspnea. When taken into the stomach it produces all the symp- 
toms of corrosive poisoning. 

The drug is an active caustic, deodorant, and disinfectant. It 
was formerly extensively employed, particularly during the Civil 
War of the United States, for the treatment of hospital gangrene, 
for which it is a most efficient remedy. Bromine has also been used 
as an injection (i part to 3 of alcohol) in various forms of cancer. 
Owing to the pain attending the operation, however, the treatment 
has not been generally adopted. 

Bromine is an efficient disinfectant, and has been employed to 
disinfect and deodorize the atmosphere of hospitals, etc. Berlin 
sanitary officials declare that " 3^- ounces of bromine can disinfect 
a space of 918 cubic feet, and deodorize a space of 7000 cubic feet." 



EMOLLIENTS, DEMULCENTS, AND PROTECTIVE 

AGENTS. 

Emollients are substances which soften, relax, and protect the 
tissues to which they are applied. They relieve pain and tension 
by diminishing heat and lessening the pressure on the nerves. 

Emollients and demulcents are largely interchangeable terms. 
The former are applied to the skin ; the latter, to mucous mem- 
branes. 

The principal emollients are : 

Glycerin, 

Soap liniment, 

Starch, . 

r Lard, 
Olive oil, 
Almond oil, 
Spermaceti, 
Linseed oil, 
Cacao butter, 
Petroleum, 
Paraffin, 
Petrolatum, 
Vaseline, etc. 

Hot fomentations, 

Linseed meal, 

Oatmeal, 

Bran, 

Bread, 

Flour, 

Figs, etc. 

Demulcents are substances which soothe and protect the parts 



Fats and oils, 



Poultices, 



TOPICAL REMEDIES. 595 

to which they are applied. They are generally of a mucilaginous 
nature, and are employed for their action upon mucous membranes, 
while emollients are principally used on the skin. 
The important demulcents are : 



Acacia, 

Barley, 

Cetraria, 

Almond, 

Flaxseed, 

Slippery elm, 


Marshmallow, 

Licorice, 

Starch, 

Tragacanth, 

Glycerin, 

White of eggy 


Sassafras-pith, 
Isinglass, 
Honey, 
Gelatin, 
Bland oils. 


oth emollients 


and demulcents are 


exceedingly useful a 



agents 
to relieve irritation of the skin in certain cutaneous diseases ; by 
softening the skin and mucous membranes they also prevent crack- 
ing or chapping from exposure to cold. They are also efficient 
agents to prevent bedsores and to lessen friction between approx- 
imating surfaces, as between the nates and about the groins of 
children. 

Demulcents are employed internally with good results when 
there is an irritated or inflamed condition of mucous membranes, 
whether of the respiratory, gastro-intestinal or genito-urinary tracts, 
as in bronchitis, gastritis, enteritis, diarrhea, dyse?ttery, strangury, 
cystitis, etc. 

Demulcents — such as flaxseed, slippery elm, marshmallow, 
or sassafras- pith — are very agreeable and efficient agents to quench 
thirst and to relieve the irritation of mucous surfaces in febrile 
affections. 

Protectives are agents used to mechanically cover and protect 
injured or diseased surfaces from extraneous influences, as from 
air, water, etc. 

Certain agents classed as protectives are employed for their 
absorptive power of taking up by capillary attraction any moisture 
or fluid present. 

They are useful agents as protective coatings to bedsores or to 
excoriated, abraded, or burned surfaces. 

The principal protectives are : 

Collodion, 

Solution of gutta-percha, 

Solution of sodium silicate, 

Court-plaster (emplastrum ichthyocollae), 

Lycopodium, 

Charcoal, 

Animal charcoal, 

Purified cotton. 

The emollients, demulcents, and protectives which are deemed 
sufficiently important to merit more consideration than has been 
given them elsewhere in the present work, will be here considered. 



596 A TEXT-BOOK OF MATERIA MEDICA. 

Glycerinum— Glycerini— Glycerin. 77. S. jP. 

Origin. — A liquid obtained by the decomposition of vegetable or animal fats or 
fixed oils, and containing not less than 95 per cent, of absolute glycerin. 

Description and Properties. — A clear, colorless liquid, of a thick, syrupy 
consistence, oily to the touch, odorless, very sweet and slightly warm to the taste. 
When exposed to the air it slowly abstracts moisture. Specific gravity not less than 
I.246. Soluble in all proportious in water or alcohol ; also soluble in a mixture of 3 
parts of alcohol and I part of ether, but insoluble in ether, chloroform, carbon disul- 
phide, benzin, benzol, and fixed or volatile oils. 

D ose- — 5-60 minims (0.3-4.0 Cc.) [1 fluidram (4 Cc), U. S. P.]. 

Official Preparations. 

Glyceritum Amyli — Glyceriti Amyli — Glycerite of Starch. — Starch, 10; 
water, 10 ; glycerin, 80. 

Used internally or externally. 

Suppositoria Glycerini — Suppositoria (ace.) Glycerini — Suppositories of 
Glycerin. — Each suppository contains 93 grains (6.0 Gm.) of glycerin. 

Used as required. 

Gelatinum Glycerinatum — Gelatini Glycerinati — Glycerinated Gelatin. — A 
mixture of equal parts of gelatin and glycerin. The mass when cold is solid, but 
easily melts on applying gentle heat. 

Basis for suppositories and bougies. 

Of late years both ointments and cerates have been largely superseded, especially 
in Europe, by dertamologic pastes and glycerogelatins. The former are mixtures of the 
medicinal agents with starch, dextrin, or kaolin, and glycerin, soft soap, petrolatum, or 
lard, and are intended chiefly for antiseptic, astringent, or germicidal effects. The 
glycero-gelatins are firmer than the pastes, and must be melted before they can be 
applied (Hunt). 

Glycerin is also contained in the following official preparations : 

Glyceritum Phenolis, Glyceritum Acidi Tannici, Glyceritum Boroglycerini, 
Glyceritum Hydrastis, Mucilago Tragacanthae, Massa Hydrargyri, Pilulae 
Phosphori,, and in many extracts and fiuidextracts. 

Antagonists and Incompatibles. — Glycerin is incompatible 
with potassium permanganate and with chromic acid. 

Synergists. — Its emollient properties may be enhanced by 
other emollients and demulcents. 

Physiological Action. — Externally and Locally. — When glyc- 
erin is applied to the skin or mucous membrane it is ordinarily 
bland and unirritating, although in certain cases the drug occasions 
a sensation of burning and smarting, which may be due either to 
an impure preparation, the rapid absorption of water from the 
tissues, or merely to a marked idiosyncrasy on the part of the 
patient. Should the pure drug show a tendency to irritate the 
skin, the glycerin should be properly diluted with water. 

Preparations more concentrated than the specific gravity recom- 
mended by the U. S. Pharmacopoeia — viz. 1.246 — should be avoided, 
because of their irritating properties. 

Glycerin abstracts water from the tissues, and is rapidly absorbed 
through the skin. It possesses marked diffusive power, being 
capable of diffusing itself freely over and through organic matter. 

Internally. — The principal action of glycerin when taken inter- 



TOPICAL REMEDIES. 597 

nally is that of a purgative. The drug purges when given by the 
rectum, either as an enema or in the form of a suppository. 

Glycerin is readily absorbed from the alimentary canal, and it 
is thought to undergo oxidation, thereby acting as a food and in- 
creasing body-weight. Some competent investigators allege that 
it is not in the least degree nutritious. 

When immoderate amounts of the drug are taken, it may be 
detected in the urine, while under excessive doses effects may be 
produced similar to those resulting from alcoholic poisoning. 

Following the ingestion of very large doses, there may be 
extreme muscular weakness, dryness of mucous membranes, dark- 
colored urine, collapse, and death. The drug is not considered 
poisonous, excessive amounts being necessary to produce the 
symptoms above described. 

Therapeutics. — Externally and Locally. — Glycerin is a popular 
and efficient remedy for chapped hands and slight excoriations. 

Fissured 7iipples and fissure of the anus are well treated with 
pure glycerin or with glycerin and tannic acid. The drug also 
makes an efficient application to bedsores. 

Glycerin is employed as an injection in gonorrhea. It may be 
used alone or medicated with bismuth subnitrate or with extract 
of opium. 

Glycerin is one of the best solvents for hardened cerumen, and 
tampons wet with glycerin or with glycerite of tannic acid are 
very serviceable in leucorrhea and erosion of the cervix, and endo- 
metritis with congestion and subinvolution of the uterus. 

Glycerin possesses marked antipruritic properties, and, whether 
applied pure or combined with oils or ointments, will allay itching 
of most affections of the skin. 

Lotions or diluted aqueous solutions of glycerin are fre- 
quently employed in various diseases of the ear, nose, and throat, 
such as fissure of the tongue ', chronic laryngitis, chronic nasal catarrh, 
coryza, pharyngitis, etc. 

A mixture of glycerin and water will lessen or prevent dry- 
ness of the mouth from fever or other causes. 

Glycerin is an efficient topical remedy for the reduction of 
edema of the prepuce, and is a serviceable antiseptic dressing for 
wounds, carbuncles, boils, etc. 

Glycerite of starch is an excellent soothing emollient in 
acute eczema, and quite an efficient preparation to prevent pitting in 
variola. 

Internally. — The principal internal use for glycerin is for the 
relief of habitual constipation , being far more efficient in habitual, 
than in occasional, constipation, and more generally applicable to 
females than to males, and to those cases where the fecal mass is 
retained in the rectum than in the sigmoid flexure or above it. 
For the purpose of relieving constipation it may be given by the 
mouth, alone or associated with castor oil, or I or 2 fluidrachms 
(4.0-8.0 Cc.) injected into the rectum, or, which perhaps is the 



593 A TEXT-BOOK OF MATERIA MEDIC A. 

most agreeable method, by the insertion into the rectum of a 

GLYCERIN SUPPOSITORY. 

Administration. — Whether glycerin be used externally or in- 
ternally, it should always be chemically pure, otherwise much irri- 
tation may be produced. 

For external use it may be used pure or mixed with water, or 
in various lotions, ointments, etc. 

Internally it is seldom given alone, but with syrups, water, wine, 
or other alcoholic liquors. 

Adeps Lanae— Adipis Lanae— Wool-fat. U. 8. I>. 

Definition. — The purified fat of the wool of sheep, freed from water. The 
hydrous wool-fat, which contains "not more than 30 per cent, of water," is still 
retained in the Pharmacopoeia ; if this be heated on the water-bath, with stirring, until 
it ceases to lose weight, it is converted into adeps lanoe. 

In making certain ointments, the water contained in hydrous wool-fat is objec- 
tionable ; for such preparations adeps lanae is preferable. 

Petrolatum Album— Petrolati Albi— White Petro- 
latum. U. 8. P. 

" A white unctuous mass of about the consistency of an ointment." It is purified 
petrolatum and is used in the preparation of the ointment of boric acid, the ointment 
of phenol (Unguentum Acidi Carbolici, U. S. P., 1890), etc. 

Oleum Olivae— Olei Olivae-Olive Oil. U. 8. JP. 

Origin. — The fixed oil expressed from the fruit of Olea europaia L. , a shrubby, 
thorny, medium-sized tree, indigenous in Western Asia, but cultivated in the countries 
bordering on the Mediterranean and in the Southern United States, California, and 
several South American and other countries. 

Description and Properties.— A pale-yellow or light greenish-yellow, 
oily liquid, having a slight, peculiar odor, and a nutty, oleaginous taste, with a faintly 
acrid after- taste. Very sparingly soluble in alcohol, but readily soluble in ether, 
chloroform, or carbon disulphide. Olive oil should be kept in well-stoppered bottles, 
in a cool place. 

Dose. — Freely. 

Physiological Action and Therapeutics. — Olive oil is a singu- 
larly bland and agreeable oil, and very useful as an emollient and 
demulcent. It serves as an efficient protective to the skin, from 
which it is readily absorbed. As a lenitive and protective in cases 
of superficial wounds, bruises, excoriations, burns, bites and stings of 
zjisccts, sprains, etc., it serves a valuable purpose. 

It is extensively employed by dermatologists to soften and facili- 
tate the removal of crusts, scales, and epithelial debris of various 
cutaneous disorders. 

The application of warm olive oil, made with gentle friction, to 
painful and engorged mammary glands during pregnancy and after 
parturition generally lessens the pain and swelling. 

The drug is an efficient palliative in painful deglutition, and is 
sometimes injected into the rectum as a soothing emollient in dys- 



TOPICAL REMEDIES. 599 

entery, and to destroy " seatworms " and allay the irritation pro- 
duced by them. 

Frequently the forcible injection into the urethra of olive oil will 
dilate an unusually tight stricture, partly overcoming the difficulty 
to the introduction of a sound. 

Olive oil is habitually employed as a lubricant for sounds, cathe- 
ters, specula, pessaries, etc. 

Where a fat or an oil is not contraindicated, olive oil is one of 
the most efficient demulcents to administer in cases of poisoning 
from corrosive irritating drugs. 

Olive oil is a useful and pleasant laxative, and is used to a con- 
siderable extent for that purpose. The oil is also credited with 
facilitating the discharge of gall-stones. It unquestionably increases 
the secretion of bile, which may account for its apparent influence 
in favoring the expulsion of these concretions. 

Oleum Amygdalae Expressum— Olei Amygdalae 
Expressi— Expressed Oil of Almond. IT. S. JP. 

Origin. — A fixed oil expressed from bitter or sweet almond (Prunus Amygdalus, 
var. amara and dulcis, De Candolle), a tree 15 to 20 feet (5 to 6 M.) high, indige- 
nous in Western Asia and cultivated in subtropical countries. 

Description and Properties. — A clear, pale, straw-colored or colorless, 
oily liquid, almost inodorous, and having a mild, nutty taste. Only slightly soluble 
in alcohol ; soluble in ether and in chloroform in all proportions. It should be kept 
in well-stoppered bottles, in a cool place. 

Dose. — 1-4 fluidrams (4.0-8.0 Cc.) [1 fluidounce (30 Cc), U. S. P.]. 

Expressed oil of almond is contained in unguentum aquae rosae. 

Physiological Action and Therapeutics, — The expressed oil 
of almond is a peculiarly bland and agreeably efficient demulcent 
and emollient, being used both externally and internally for the 
same purposes as olive oil. 

Oleum Lini— Olei Lini— Linseed Oil. 77. S. -P. 

(Oil of Flaxseed.) 

Origin. — A fixed oil expressed without heat from the seed of Linum Usitatissi- 
mum L. 

Description and Properties. — A yellowish or yellow oily liquid, having a 
slight, peculiar odor, and a bland taste. When exposed to the air it gradually thickens 
and acquires a strong odor and taste ; when spread in a thin layer on a glass plate, 
and allowed to stand in a warm place, it is gradually converted into a hard, transpar- 
ent, resin-like mass. Soluble in about IO parts of absolute alcohol, and, in all pro- 
portions, in ether, chloroform, benzin, carbon disulphide, or oil of turpentine. Lin- 
seed oil should be kept in well-stoppered bottles. 

Dose. — \-2 fluidounces (15.0-60.0 Cc.) [1 fluidounce (30 Cc), U. S. P.]. 

Physiological Action and Therapeutics. — The action and uses 
of flaxseed oil are similar to those of olive oil. One of its most 
important uses, when mixed with an equal quantity of lime water, 
is in the treatment of burns. 

The linseed itself is used extensively as a domestic demulcent 
in the form of a tea, for cough, etc., while the ground linseed makes 
an excellent poultice for all deep-seated inflammations. 



600 A TEXT-BOOK OF MATERIA MEDIC A. 

Acacia— Acaciae— Acacia. 77. S. P. 

(Gum Arabic.) 

Origin. — A gummy exudation from Acacia Senegal Willdenow, and other species 
of acacia, small trees, about 20 feet (6 M. ) high, found in India and Africa, espe- 
cially in the district of Khartoum, westward to Senegambia. 

Description and Properties. — In roundish tears of various sizes, or 
broken into angular fragments, with a glass-like, sometimes iridescent fracture, 
opaque from numerous fissures, but transparent and nearly colorless in thin pieces ; 
nearly inodorous, taste insipid, mucilaginous ; insoluble in alcohol, but soluble in 
water, forming a thick mucilaginous liquid. Acacia should be slowly but completely 
soluble in 2 parts of water. 

Official Preparations. 

Mucilago Acaciae — Mucilaginis Acacia — Mucilage of Acacia (34 per cent.). 
— Dose. — Freely. 

Syrupus Acaciae — Syrupi Acaciae — Syrup of Acacia. — Dose, freely. 

Acacia is contained in Emulsum Amygdalae, Pulvis Cretae Compositus, and 
in some trochisci. 

Physiological Action and Therapeutics. — Acacia is a valuable 
demulcent, and gum-water is in ordinary use to serve as a protective 
to inflamed and irritated mucous membranes of the respiratory, 
alimentary, and genito-urinary tracts, as in cases of pharyngitis, 
laryngitis, dysentery, gastritis, typhoid fever, and in febrile affections 
generally. . The mucilage of acacia is sometimes used as a pro- 
tective for superficial burns, excoriations, etc. 



Ulmus— Ulmi-Elm. 77. S. P. 

(Slippery Elm.) 

Origin. — The inner bark of Ulmus fulva Michaux, a medium-sized tree, from 30 
to 60 feet (9-18 M.) high, found in the United States and Canada. 

Description and Properties. — In flat pieces, varying in length and width, 
about % inch ( 3 Mm. ) thick, tough, pale-brownish white, the inner surface finely ridged ; 
fracture fibrous and mealy ; the transverse section delicately checkered ; odor slight, 
peculiar ; taste mucilaginous, insipid. 

Official Preparation. 
Mucilago Ulmi — Mucilaginis Ulmi — Mucilage of Elm. — Dose, freely, 

Physiological Action and Therapeutics. — Elm is a decided 
demulcent and possesses nutritive properties. It is pleasant to the 
taste and does not readily disturb the stomach. It is principally 
used as a demulcent in diseases of the gastro-intestinal and genito- 
urinary tracts, as diarrhea, dysentery, cystitis, urethritis, etc. The 
fibrous bark is molded into tents used to dilate the neck of the 
uterus, fistulous openings, etc. 

In the form of troches (elm lozenges) ulmus is excellent in the 
treatment of sore throat. 



TOPICAL REMEDIES. 601 

Althaea— Althaeae— Althaea. U. S. P. 

(Marshmallow. ) 

Origin. — The dried root of Althcea officinalis L., a perennial herb indigenous in 
the temperate portion of Northern and Western Asia and in the greater part of Europe. 

Description and Properties. — In cylindrical or somewhat conical pieces, 
from 4 to 6 inches (10-15 Cm. j long, about \ inch (12.7 Mm. ) thick, deeply wrinkled, 
deprived of the brown corky layer and small roots ; externally white, marked with a 
number of circular sputs, and of a somewhat hairy appearance from the loosened bast- 
fibers; internally whitish and fleshy. It breaks with a short, granular, and mealy 
fracture, and has a faint, aromatic odor and a sweetish, mucilaginous taste. It contains 
asparagin, mucilage, sugar, and pectin. 

Physiological Acion and Therapeutics. — Marshmallow is 
emollient, demulcent, and protective, and is an efficient protective 
and emollient in irritable and inflamed conditions of the skin, and 
a highly efficacious demulcent in all inflammatory and irritable 
conditions of the respiratory, digestive ', and urinary organs. 

Tragacantha— Tragacanthae— Tragacanth. 77. S. P. 

Origin. — A gummy exudation from Astragalus gutnmifer Labillardiere, or from 
other species of Astragalus, low shrubs, indigenous in a portion of the territory lying 
between Eastern Persia and Greece. 

Description and Properties. — In narrow or broad bands, more or less curved 
or contorted, marked by parallel lines or ridges, white or faintly yellowish, translucent, 
horn-like, and tough. It contains 33 per cent, of a gum, bassorin, which is only slightly 
soluble in water. 

Official Preparation. 

Mucilago Tragacanthae — Mucilaginis Tragacanthse— Mucilage of Traga- 
canth. — Dose, freely. 

Physiological Action and Therapeutics. — Tragacanth is de- 
mulcent and nutritious, and may be used for the same purposes 
as acacia, Iceland moss, etc. The mucilage of tragacanth is sin- 
gularly efficacious as a soothing emollient in chapped hands and 
irritable conditions of the skin. 



Sassafras Medulla— Sassafras Medullae— Sassafras 

Pith. 77. S. r. 

Origin. — The dried pith of Sassafras variifolium (Salisbury) O. Kuntze, a tree 
indigenous in North America. 

Description and Properties. — In slender, cylindrical pieces, often curved 
or coiled, light, spongy, white, inodorous, and insipid. Macerated in water, it forms a 
mucilaginous liquid, which is not precipitated by the addition of alcohol. 

Official Preparation. 

Mucilago Sassafras Medullae — Mucilaginis Sassafras Medullas — Mucilage 
of Sassafras Pith. — Dose, freely. 

Physiological Action and Therapeutics. — Mucilage of sassa- 
fras pith is an agreeable demulcent and a mild local stimulant, and 



602 A TEXT-BOOK OF MA TERIA MEDICA. 

may be used for the same purposes as slippery elm, tragacanth, 
acacia, etc. It forms a pleasant vehicle for more active remedies. 

Chondrus— Chondri— Chondrus. 

(Irish Moss.) 

Definition. — The dried plant of Chondrus crispus (L.) Lyngbe. 
One part of chondrus boiled with 30 parts of water yields a solution which gela- 
tinizes on cooling. 

Dose. — As a demulcent drink, 15 grains (£ ounce), U. S. P. 

Kaolinum— Kaolini— Kaolin. U. S. J?. 

Definition. — A native aluminum silicate, consisting largely of the pure silicate, 
II 2 Al 2 Si 2 8 + H 2 0. It is a very pure clay. 

Properties. — Soft, white or yellowish-white powder, odorless, and having an 
earthy or clay-like taste. 

Insoluble in water. 

Kaolin is contained in Cataplasma Kaolini (q. v. ). It is used in dusting-powders ; 
also in pills containing easily reduced bodies, such as silver nitrate or potassium per- 
manganate, which cannot be mixed with ordinary excipients. 

Official Preparation. 

Cataplasma Kaolini — Cataplasmatis Kaolini — Cataplasm of Kaolin 

I U. S. P.). — Introduced in response to a request for an external clay preparation; 
similar to a number of commercial articles. The constituents are kaolin (57.7 per 
cent. ), boric acid, methyl salicylate, glycerin, and small quantities of thymol and oil 
of peppermint. 

Used as a poultice in mild local infections. Usually applied hot. 

Talcum— Talci— Talc. U. S. P. 

Definition. — A native hydrous magnesium silicate, official under the same name 
in the German Pharmacopoeia. 

Many of the commercial talcum powders contain talc and boracic acid. 

Properties. — Talc occurs as a grayish-green solid with waxy luster, or a white 
or pale-gray powder. It feels greasy to the touch, hence it is popularly called soap- 
stone. It is used as a dusting-powder, and in some pill-masses. 

Talcum Purificatum— Talci Purificati— Purified 
Talc. U. S. P. 

Talcum purified by treatment with hydrochloric acid. Used in the pharmacopceial 
method of preparing certain official waters of volatile oils. 

The same preparation is to be found in the National Formulary. 

Ceratum Resinae Compositum— Cerati Resinae 
Composita— Compound Rosin Cerate. U. S. JP. 

Composed of rosin, yellow wax, suet, turpentine, and linseed oil. 

Emplastrum Adhaesivum— Emplastri Adhaesivi— 
Adhesive Plaster. U. S. r. 

This is to take the place of Emplastrum Resinae (U. S. P., 1890), from which it 
differs chiefly in the substitution of rubber for rosin. 

For formula and method of preparation see the Pharmacopoeia. 



TOPICAL REMEDIES. 603 

Paraffinum— Paraffini— Paraffin. 77. S. -P. 

Definition. — A mixture of solid hydrocarbons, chiefly of the methane series. 
The paraffin of the U. S. Pharmacopoeia melts between 51. 6° and 57. 2 C. (124.9- 
135 F.). The " hard paraffin " (paraffinum durum) of the British Pharmacopoeia melts 
between 54.4 and 57. 2° C. (129.9-135 F.), while the "paraffinum solidum" of the 
German Pharmacopoeia melts between 74 and 8o° C. (165,2-176° F.). 

Gelatinum— Gelatini— Gelatin. U. S. I>. 

The U. S. Pharmacopeia demands that upon ignition it leaves not more than 2 per 
cent, of ash. Most of the gelatin on the market has an acid reaction. 

Lycopodium— Lycopodii— Lycopodium. 77. S. JP. 

Origin. — The spores of Lycopodium clavatum L. and of other species of lycopo- 
dium, low-creeping perennials found in dry woods, distributed over the greater portion 
of the globe. 

Description and Properties. — A fine powder, pale yellowish, very mobile, 
inodorous, tasteless, floating upon water and not wetted by it, but sinking upon being 
boiled with it, and burning quickly when thrown into a flame. Under the microscope 
the spores are seen to be sphero-tetrahedral, the sufaces marked with reticulated ridges, 
and the edges beset with short projections. Lycopodium contains a fixed oil and a 
minute quantity of a volatile base, methylamine. 

Used principally externally. 

Physiological Action and Therapeutics. — Lycopodium is an 
admirable protective, and possesses great power of absorbing oils. 
Its lightness, dryness, and absorptive power render it an excellent 
dusting-powder for excoriated surfaces, eczema, herpes, intertrigo 
erysipelas, superficial ulcers, etc. 

Its peculiar property of not being wetted with water makes it 
a valuable protective to prevent irritation or chafing caused by the 
urine or alvine dejections of infants. 

The drug is used as a basis for insufflations and in pharmacy 
to prevent the adhesion of pills. 

Unguentum— Ung-uenti— Ointment. U. S.P. 

White wax, 20 ; benzoinated lard, 80, constitute the base of simple ointment. 
Another emollient ointment is Unguentum Aquae Rosae. 






ANIMAL EXTRACTS (ORGANOTHERAPY). 



The striking fact that various excretions and tissues of the living 
organism, when administered under certain conditions, possess a 
peculiar therapeutic value is now well ascertained. The idea, al- 
though generally considered an innovation in therapeusis, has 
long been the subject of studious attention, yet only in recent years 
has the practical application of organtherapy claimed professional 
recognition, and the nature and operation of its curative properties 
acquired unprecedented significance. Extracts derived from al- 
most every portion of the human system, together with many 
animal secretions, have been prepared, and their efficacy tested by 
searching experiment. It was reserved for the noted investigator, 
Brown-Sequard. and his associates to inaugurate, as late as 1 889, 
the system of organotherapeusis as known to-day and promulgate 
the theory resulting in the now-established medicinal potency of 
glandular extracts. 

Among the earliest and most original essays prompted by the 
new procedure was Brown-Sequard's hypodermic injection of an 
extract from the recent testicles of mammals, in the treatment of 
senile debility. It should be noted, in passing, that, curiously enough, 
as there is no new thing under the sun, this special employment of 
organic extract for the relief of morbid conditions finds an analogue 
in a custom of very ancient origin, the high authority of Pliny, the 
historian, attesting that the Grecian and Roman debauches were 
won't to consume the testicles of asses to restore their dissipated 
energies. 

While it must be admitted that the benefits derived from the 
administration of testicular juice have failed to realize the ardent 
anticipations of its earlier advocates, we may cheerfully concede that 
the experimental impetus imparted by it to clinical and therapeutic 
investigation has added considerably to our scientific knowledge in 
the realm of medicine and gone far to alleviate the ills of suffering 
humanity. 

Up to the present time, however, it cannot be stated with posi- 
tiveness that organic extracts derived from the testes, the ovaries, 
or the mammary glands have any marked specific action on the 
respective organs. The excellent results obtained in some cases 
arc unquestionably to be attributed to the influence of suggestion. 
More extended study of active principles, should such be found to 
exist per se, is desirable before a final word can be spoken con- 
cerning these extracts. 

604 



ANIMAL EXTRACTS {ORGANOTHERAPY.) 605 

Glandulae Thyroideae Siccae— Gland ulae Thyroidse 
Siccae— Desiccated Thyroid Glands. V. S. JP. 

Definition. — The cleaned, dried, and powdered thyroid glands of the sheep, 
freed from fat. 

Description and Properties. — A yellowish amorphous powder, having a 
slight, peculiar odor ; partially soluble in water. 

Dose. — Average dose : 4 grains (0.250 Gm. = 250 milligrammes), U. S. P. 

Numerous extracts of the thyroid are upon the market, many of them purporting 
to be the active constituent. A iodine, opothyroidine, and thyroglanaine are other 
preparations on the market. 

Thyreoidectin and rodagen represent a new series of preparations quite recently 
introduced which must not be confused with the above; their action is stated to be 
exactly the opposite of that of the thyroid preparations. Thyreoidectin is prepared 
from the blood, rodagen from the milk, of animals from which the thyroids have been 
removed. 

Numerous chemical studies made during the past few years have 
seemed to show that the action of the thyroid extract is due to a 
peculiar body rich in iodine. It is found principally in the colloid 
substance of the gland, and is rich in globulin, a thyreoglobulin 
from which a principle, iodothyrin, has been insolated. Although 
much remains to be learned concerning this iodothyrin, it is safe to 
assume it as the active principle of the gland. It varies greatly in 
amount in different glands and at different ages in the human subject. 

The most rational and successful application of organotherapy, 
perhaps, was that of Murray in 1891, who, following Horsley's 
deductions from Kocher's surgical results, proposed the subcuta-, 
neo us injection of a thyroid extract in the treatment of myxedema, 
many cases of which have improved, while others have been defi- 
nitely cured by the adoption of the remedy. The preparations in 
this case have included the ingestion of the dry powder, the injec- 
tion of a glycerin extract, and the raw or partially cooked gland 
administered as food. The testimony of competent authorities 
amply attests the efficacy of the agent, which now receives almost 
universal acceptance. It has, therefore, been made official in the 
Pharmacopoeia of 1900. 

Action. — If injected into the veins of animals, iodothyrin causes 
an acceleration of the heart action, lowers the blood-pressure, in- 
creases the amount of urine excreted, and may give rise to dyspnea 
and diarrhea. It seems probable that many of the peculiar toxic 
symptoms that were observed when the older extracts were in use 
were in reality due to the presence of putrefactive ptomains. In 
large doses, in man, symptoms somewhat similar to those observed 
in exophthalmic goiter have been reported. Iodothyrin has also 
the effect of increasing catabolism and* produces a marked 
breaking-down of proteids, in this way causing loss of flesh. This 
effect, combined with its diuretic action, renders it valuable in the 
treatment of obesity. 

Therapeutics. — With the treatment of myxedema, cretinism, 
Basedow's disease, lipomatosis universalis, cachexia strumipriva, and 
thyroid insanity, it would seem as if the use of thyroid had reached 
its limitations. The successful administrations and beneficial results 



606 A TEXT-BOOK OF MATERIA MEDICA. 

obtained in some of the above diseases, however, have stimulated 
many observers and experimenters to make a wider trial of this 
form of medication. Psoriasis has been helped by its use. 

The dosage, method of administration, and danger-signals are 
no less important than the indications for its use. The hypodermic 
administration of the liquid extract and the grafting of the fresh 
gland have long fallen into disuse, and the tendency of the present 
day is to administer the powder or to give tablets or capsules pre- 
pared from the desiccated fresh gland. The dose varies with the 
individual, and for this reason it is advisable to begin with small 
doses, which should be gradually increased until the desired effect 
is produced. Beginning with I or 2 grains a day, as much as 
1 5 grains may be administered, the prescriber always being on 
the qui vive for poisonous symptoms. During the course of ad- 
ministration especial attention should be given to the respiratory 
and cardiac apparatus, and at the first appearance of rapid pulse, 
embarrassed respiration, rise of temperature, vertigo, or gastric dis- 
turbance, its use should be abandoned. 

Improvement has been noted in several cases of malignant 
syphilis, Menzies considering that thyroid acts as a powerful skin- 
tonic and a useful adjuvant to mercury and potassium iodide in the 
treatment of this disease. 

The favorable results often attending the partial employment of 
animal agents in diseases of corresponding organs, and especially 
the noteworthy benefits derived from the application of the thyroid 
treatment in myxedema, have suggested the preparation of many 
extracts of varying efficacy. 

Parathyroid Gland. — These glands when given in animals are 
capable of causing muscular tremor and other symptoms. It has 
been suggested that they may prove of value in treating patho- 
logical tremors, particularly paralysis agitans. 

Thymus Gland — This organ contains bodies rich in iodine 
similiar to those found in the thyroid, but as yet no therapeutic ap- 
plication has been followed by marked success. 

Pituitary Body. — Inasmuch as acromegaly has been found to 
be associated very frequently with disease of the pituitary body it 
has been suggested that this body might be of some service, but 
thus far success in its use for this disease has been negative. The 
gland is a complex structure anatomically, and further research 
may give some results. 

Nuclein is a complex proteid body, characterized by its large 
percentage of phosphorus. The phosporus exists in the form of 
nucleinic acid ; so far as is known, this acid is the same in all cells, 
yet the basic part differs in various nucleins. 

When administered hypodermically or orally, nuclein increases 
the number of leucocytes in about three hours. The amount of 
increase varies with the subject; it may be slight or it may be three- 
fold ; it occurs principally in the polynuclcar cells. 

Nuclein is of some value in conditions of infection where the 



ANIMAL EXTRACTS {ORGANOTHERAPY). 607 

symptoms are due to general invasion of the bacteria. Favorable 
results are obtained in simple anemias. It is found on the market 
in a 5 per cent, solution, dose 1 to 2 drams. It should be given 
on an empty stomach. Vaughan reports that in tuberculosis the 
effect of moderate injections has been to lower the temperature, 
without untoward manifestations. Indolent ulcer has yielded com- 
pletely to a similar treatment. 

It is also stated upon high authority that the nucleins are useful 
in "all forms of anemia, in chronic and recurrent malaria, in digest- 
ive disorders, and in acute and chronic pulmonary affections " 
(Aulde), the nuclein adopted being obtained from the thyroid and 
thymus glands. The latter author suggests the use of nuclein in 
the treatment of typhoid, in which disease the activity of leucocy- 
tosis is defective. 

Bile. — This has already been treated. 

Bone-marrow has proved efficacious in anemia (Dickson, 
Frazer), and has also been employed by Filleau in tuberculosis. 

Pancreas Extracts. — These have been employed in diabetes, 
but as yet very crudely and with no effect. 

Careful technic is desirable in the use of this class of bodies, 
and their further study may be crowned with brilliant results. 

Suprarenal Glands. — These have already been discussed. 

SERUM-THERAPY. 

Among the marvels of scientific research which have distin- 
guished our century no achievements are more remarkable, nor 
of greater moment to the welfare of mankind, than those pertaining 
to the field of biologic, pathologic, and therapeutic investigation. 
The limits of the present work preclude a detailed treatment of so 
extensive and complicated a subject ; yet a brief summary, eluci- 
dating the theory and development of serum-therapy as exemplified 
in contemporaneous research, should be of interest, as well as benefit, 
to the student of modern therapeutics. 

A glance at the history of therapeutic procedure in the prophy- 
lactic treatment of infectious diseases shows that the general principle 
underlying all later discoveries had been, though crudely, divined 
at a much earlier period than we are wont to suppose. In view 
of actual attainment it is natural that the mind should revert to the 
transcendent services rendered to mankind by Jenner; yet it is 
known that the ancient Hindus and Persians, as well as the nomad 
tribes and caravans of farther Asia, practised inoculation of equine 
virus, or horse-pox — the mammary pustule developed during early 
lactation in the horse, camel, and cow, and even in woman. 

The inoculation of human virus is of immemorial origin, proba- 
bly coeval with the importation of variola from Asia into Africa by 
the Saracens. Certain it is that as early as the tenth century the 
Arabs and Chinese adopted the custom of variolization, the inoc- 
ulation of small-pox, although the skeptical physicians of the age 



6o8 A TEXT-BOOK OF MATERIA MEDICA. 

consigned the practice as a monoply to women. Of the develop- 
ments of the treatment for small-pox we refer to special works. 

It was reserved for Jenner, however, in 1776, to commence the 
systematic and exhaustive study of the subject destined to prove 
inestimably beneficial to mankind. His early experiments were but 
a repetition of the empirical, yet prophetic, test of the English farmer ; 
and it was not until 1798 that Jenner published his first paper upon 
the subject, vaccination being transported to America in the follow- 
ing year. Such is the brief, yet eloquent, record of an achievement 
wnich experience has proved to be of incalculable benefit to man. 
To-day there is no question among the more enlightened members 
of the profession that the operation, properly performed, is an 
absolute safeguard against the infection of small-pox. 

Strange, indeed, is it that a century of comparative quiescence 
should have elapsed since Jenner pointed the way to the startling 
accomplishment of the present epoch. Yet not until Pasteur, in 
1880, announced to the world the issue of his labors touching the 
protective inoculation of animals was the broken thread of patho- 
genic research taken up anew, and the task of solving its mysteries 
resumed — be it said with more profound acumen and far more com- 
plete appliances than ever before. 

It is a matter of record how the French savant demonstrated 
that cultures of the bacilli of chicken-cholera, when thoroughly 
dried and long exposed to the air, lost their virulence, and that 
fowls inoculated with the attenuated virus were rendered insensible 
to the attacks of rri3re energetic micro-organisms. It was, mutatis 
mutandis, a modification or development of the Jennerian principle : 
" The history of vaccination constitutes the first step in a long series 
of labors inspired by the admirable discoveries originating in the 
genius of Pasteur. The principle is always the same — to diminish 
the strength of the virus and inject it into the animal which we wish 
to render immune" (Bernheim). 

A striking departure from Pasteur's method by Salmon and 
Smith, in 1886-87, led indirectly to the latest evolution of inocula- 
tive therapy. They showed conclusively that animals may be ren- 
dered immune against certain infectious diseases by inoculating 
them with filtered cultures containing the toxic products of patho- 
genic micro-organisms entirely free from the living bacteria to which 
they owe their origin. By this process immunity against the bacillus 
of hog-cholera was attained in pigeons, the disease being almost 
invariably fatal to these birds. A little later (1888) Roux, employ- 
ing similar sterilized cultures, succeeded in protecting susceptible 
animals against the anthrax bacillus; and more recently (1890) 
Behring and Kitasato have proved that immunity against the action 
of the tetanus bacillus may be conferred by the use of toxic products 
in solution freed from the presence of active germs — in a word, that 
purely chemical agents sufficed to attain the object hitherto deemed 
wholly dependent upon the influence of living bacteria. The 
significance of this discovery could hardly be over-estimated. By 



ANIMAL EXTRACTS [ORGANOTHERAPY). 609 

it the entire theory of causal phenomena — the protective force in 
which the immunizing property was supposed to reside — became 
modified. If not a living organism, but a chemical substance, 
proved to be the immunizing agent, then resistance to toxic in- 
fluences must proceed from some source other than bacterial metab- 
olism — some organic force inherent in the inoculated system. To 
ascertain the nature and operation of this bactericidal power and 
determine the ratiojialc of acquired immunity now engaged the 
earnest attention of savants throughout the world. It is the 
province of the text-book of pathology to discuss the various 
problems of immunity. In this work the results only of the studies 
as applied to Therapeutics can be taken up. 

Tetanus. — The first proof that tetanus is an infectious disease, 
of ballicary origin, was furnished by Carle and Cattone, who in 1884 
reproduced the symptoms in a rabbit by inoculation of pus taken 
from a human tetanus wound. The bacilli were found in the ad- 
jacent soil, but it was not until 1889 that Kitasato succeeded in 
isolating pure cultures, proving conclusively the microbic nature of 
the disease. 

The earliest case treated with antitoxin was reported in 1 891 by a 
Bolognese physician, Dr. Gagliardi, the result being very satisfactory. 

In December, 1890, Behring and Kitasato demonstrated that 
the serum of animals rendered immune against tetanus by the 
injection of iodine trichloride in the blood was capable of neutral- 
izing tetanic poison, whether in the laboratory or in other animals, 
the property not being possessed by organisms not inoculated. 
Not only did they succeed in preventing infection, but they recog- 
nized in the serum a curative power, as shown in the inoculation 
and cure of mice. At the same time it was observed by Vaillard 
that the immunity conferred by the serum was of short duration, 
lasting only fifteen days. 

Kitasato's preventive injection — a mixture of living culture and 
gradually decreasing doses of iodine trichloride — was perfected by 
Behring, who successfully applied it to the mouse, rabbit, sheep, 
and horse. Various results of experimental research ensued, elicit- 
ing, among other interesting phenomena, the fact that removal of 
the spleen renders immunization impossible. In 1891, Vaillard 
showed that the serum of animals naturally immune is not anti- 
toxic, becoming so only after a powerful dose of tetanic poison, and 
that the spleen and the fluids of immunized subjects are devoid of 
antitoxic properties. 

The present status of tetanus antitoxin is not settled. It has not 
fulfilled all that was hoped for it, yet, injection into nerve trunks 
and within the cerebral substance has in the early stages proved to 
be of some service. Meltzer has recently suggested magnesium sul- 
phate by intrarachidian injections, and Blake has reported a phenom- 
enally successful result following its use. 

Diphtheria. — It is in the treatment of this universal and terrible 
disease that serum-therapy has achieved its most signal triumphs, 

39 



610 A TEXT-BOOK OF MATERIA MEDICA. 

the marvels wrought by its influence attracting more and more the 
attention both of the medical profession and of the laity. 

The micro-organism of the malady was described by Klebs in 
1883, his investigations being quickly followed by those of Loeffler, 
who confirmed Klebs' discovery and announced that it was possible 
not only to insolate, but also to produce, cultures of the microbe. 



Serum Antidiphthericum— Sera Antidiphtherici— 
Antidiphtheric Serum. 

(Diphtheria Antitoxin.) 

Definition. — A fluid separated from the coagulated blood of a horse immunized 
through the inoculation of diphtheric toxin (U. S. P.). The German Pharmacopoeia 
recognizes also the dried serum. 

Antidiphtheric serum gradually loses its power, the loss in one year varying between 
10 and 30 per cent. " The standard of strength, expressed in units of antitoxic power, 
should be that approved or established by the U. S. Public Health and Marine- Hos- 
pital Service" ( U. S. P.). All manufacturers selling diphtheria antitoxin in the 
District of Columbia, or in States other than the one in which it is manufactured, 
must secure a license issued by the Secretary of the Treasury, on recommendation of 
the Surgeon-General of the Public Health and Marine-Hospital Service. 

Dose. — Average dose : 3000 units. Immunizing dose for well persons, 500 
units (U. S. P.). 

The serum has now been made official in the U. S. Pharmacopoeia. 

Caution. — Should be kept in sealed glass containers in a dark place at tempera- 
tures between 4.5 and 15° C. (40^ and 59 F.). 

From a careful consideration of the subject in its relations to 
diptheria, we may safely conclude : 

1. That immunized serum forms a remedy which experience 
proves to be wholly innocuous and eminently adapted for use in 
human infection. 

2. That antidiphtheritic serum has in every respect corre- 
sponded with the most sanguine hopes of its advocates, its employ- 
ment being attended with astonishing success wherever properly 
used and in sufficient quantities. 

3. Finally, that it is incontrovertibly established that by means 
of injecting serum temporary immunity from infection may be readily 
conferred, permanent protection being' contingent merely upon a 
renewal of treatment. 

The present status of diphtheria antitoxin may be presented in a 
few words. It has established itself as a specific in the treatment of 
this disease. During the past year the use of larger doses has be- 
come more general, and it seems certain that better results are 
obtained. The administrators of the Chicago Department of 
Health give 2000 units in all cases of suspected diphtheria, and 
employ 1000 units as an immunizing dose. During the months of 
November and December this department treated 219 cases of 
bacteriologically proved diphtheria, all charity cases, with a death- 
rate of 4. 1 per cent. Some two and a half years ago, when antitoxin 
was not used, the death-rate from diphtheria treated by this depart- 
ment was about 35 per cent. 



ANIMAL EXTRACTS {ORGANOTHERAPY). 6il 

Tuberculosis. — It may be stated, in general terms, that the 
microbic nature of tuberculosis was admitted by nearly all writers 
upon the subject before the discovery of the pathogenic micro- 
organism. Villemin in 1866 had established by experiment the 
infectious character of the malady ; but in France the idea seemed 
almost revolutionary, creating no enthusiasm, it being reserved for 
Germany, through the indefatigable labors of Robert Koch, to 
develop and elucidate the theory conceived by Villemin. Koch 
discovered the bacillus of tuberculosis, and even succeeded in iso- 
lating and cultivating it, the pure cultures obtained by him always 
producing tuberculosis in eveiy form. His original communication, 
addressed to the Physiological Society of Berlin, bore date of April 
10, 1882, and at once stimulated experimental research in others, 
who fully confirmed his discovery. 

Various methods of inoculation have been adopted in tubercu- 
losis : 1, Inoculating the patient with another disease; 2, inocula- 
tion with attenuated tuberculosis or that proceeding from a different 
species, as from birds ; 3, inoculation of the soluble bacillar prod- 
ucts — tuberculin ; 4, injection of blood taken from animals often 
immune against tuberculosis ; 5, injection of serum drawn from 
inoculated animals ; 6, finally, injection of serum taken from 
immunized animals. With the last two of these methods we are 
properly concerned. The fifth has been scientifically adopted by 
Babes, Richard, and Hericourt, who have treated a large number 
of cases in which various cures have been effected. The main 
obstacle of the procedure lies in the difficulty of successful inocu- 
lation, the greater part of the animals employed dying of infectious 
nephritis. 

By the sixth method, as employed by Bernheim, this fatality is 
largely obviated, a careful procedure with the serum of immunized 
animals proving the most efficacious hitherto devised. The proc- 
ess of immunizing consists in injecting the toxic products nor- 
mally secreted by Koch's bacillus, and is, in effect, that adopted by 
Behring in preparing the antitoxin of diphtheria. In experiment- 
ing upon a large number of animals, suffice it to say that the results 
obtained by Bernheim were eminently satisfactory, every case 
indicating improvement, and the actual cures being about 40 per 
cent. So convinced was he of the sovereign value of his method 
that he emphatically declared it to be the only rational procedure 
possible in tuberculosis. Within recent years Magliano and Behring 
have announced important advances in the serum or vaccine treat- 
ment of tuberculosis. 

It is difficult to sum up in a few words the present status of the 
serum treatment of tuberculosis. We are not in the possession of 
any true antibodies that are of service in the direct treatment of 
patients suffering from tuberculosis, but there are excellent reasons 
for believing that an immunizing serum or vaccine is a possibility in 
the not-far-distant future. 

Pneumonia. — Inoculations of attenuated virus readily confer im- 



612 A TEXT-BOOK OF MATERIA MEDIC A. 

munity in lower animals, reduction of virulent germs be attained by 
the use of desiccated pneumonic viscera. The saliva of a patient, 
collected after defervescence, ensures protection to the mouse, the 
same being true of blood-serum. Immunization of animals was 
inaugurated by Emmerich and Fovitsky in 1891, subsequent in- 
vestigators confirming their experiments under varying conditions, 
Foa and Scabia finally employing human serum in the inoculation 
of rabbits with marked success. 

The therapeutic interest of the subject centers in the application 
of inoculation to man. The early experiments of Foa and Scabia 
were without result, neither reaction nor amelioration attending 
their treatment ; but in 1892, Klemperer reported favorably con- 
cerning immunization in 40 cases of human pneumonia. 

In January, 1893, Lava communicated to the Academy of Med- 
icine in Turin the application of serum-therapy with auspicious 
results. Ruzzolo also reported successes. Up to the present time, 
however, it cannot be said that a successful pneumococcus serum 
has been devised. 

Cholera. — The microbe of this terrible disease had been sought 
since 1848, yet the subject had never been profoundly studied until 
Koch succeeded in isolating the germ. Being associated with other 
micro-organisms, the bacillus had remained undetected, being dis- 
tinguishable, in fact, only in fulminant attacks of the disease, as was 
noted by Strauss and Roux. 

Haffkine has definitely produced results in the immunization 
against cholera. He has used his serum on a large scale in India, 
and his results are encouraging. 

Septicemia. — The streptococcus of Fehleisen (erysipelatis), 
which causes erysipelas, was discovered by Nepveu, in France, and 
Hiiter, in Germany (1868-80), and has been the subject of careful 
study by Klemperer and others, in the hope of determining its 
availability as an immunizing agent. Employing the serum of 
immunized rabbits, it has been found possible by intravenous injec- 
tion to cure the disease in mice, the serum proving efficacious only 
against the disease with which the animal supplying it was inocu- 
lated. Subsequent experiments have been attended with varying 
results, Marmorek, in February, 1895, having succeeded in obtain- 
ing a germ of streptococcus so virulent that the hypodermic injec- 
tion of tttoWo" Cc was fatal to the rabbit in thirty hours. Inocula- 
tion with this microbe or its toxins conferred immunity upon 
rabbits, which furnished a preventive and curative serum. 

Encouraged by previous experimentation, Charrin and Roget 
now sought to apply the method of serum-therapy in the treatment 
■of puerperal fever. Having satisfied themselves of the curative 
property of the serum of a mule inoculated with the microbe of 
erysipelas, collected fifteen days after the eighth inoculation, they 
injected subcutaneously 8 Cc. of serum in a woman affected with 
the fever. The report is as follows : " The next day no improve- 
ment. A second injection of 8 Cc. Next day condition slightly 



ANIMAL EXTRACTS {ORGANOTHERAPY). 613 

improved, but still serious. Third injection of 25 Cc. Result, on 
the following day rapid improvement ; decline of fever ; general 
good health ; and early establishment of convalescence." 

Antistreptococcic serum gives promise of being second only to 
the diphtheria antitoxin in point of therapeutic value. It has been 
most successful in erysipelas and puerperal septicemia. Cases of 
scarlet fever are reported where it has been useful in shortening the 
duration of the disease and preventing unfortunate complications 
and sequelae, such as otitis media and other suppurative processes 
due to streptococci. Aronson has perfected an antistreptococcic 
serum from which much is hoped. 

The latest reports on antistreptococcic serum are not so encour- 
aging as the earlier ones. 

Syphilis. — The pathogenic source of syphilis is still being sought. 
The most recent work of Schaudinn and Hofmann, corroborated 
by Flexner, Noguchi, Metschnikoff and others, would seem to show 
that a spiral organism, Spirochceta pallida, bears some relationship 
to the disease. Experimental inoculation has succeeded for lower 
animals, and the way seems to be opening up for a possible serum 
therapy of syphilis. 

Typhoid Fever. — The bacillus of this disease was first detected 
in the kidneys by Bouchard in 1879. The name was given by 
Eberth,who studied the germ in 1880-81. The old cultures contain 
an exceedingly toxic ptomain, besides a soluble substance capable 
of inoculating animals. 

Wright and Semple have devised a method of vaccine immuni- 
zation against typhoid which promises well. Bokenham has 
produced a serum, but results are as yet too few to justify thera- 
peutic conclusions. 

Reptile Poisons. — It has long been known that certain animals 
(reptiles) possess natural immunity against their own venom. The 
poison of the toad having been detected in his blood, the reptile's 
immunity was at first thought to be due to tolerance, the same 
condition existing in the salamander and viper. 

So far as it affects man, Calmette announces that he has employed 
serum with success in the treatment of snake-bites, even to the 
extent of curing them. 

Calmette's antivenin has now become perfected and is found a 
reliable mode of treating cobra-poisoning. 

Noguchi has in course of preparation an anticrotalic serum, 
against rattlesnake-poisoning, which promises well, although not yet 
perfected. 

Carbuncle (Anthrax). — The bacterium of anthrax, of the genus 
bacillus, has proved a subject of elaborate and interesting experi- 
ment, many features of which are of absorbing interest alike to the 
bacteriologist and the clinician. The animals subjected to inocula- 
tion have been chosen with great care, and those supplying the 
immunizing serum include many species. The general results of 



614 A TEXT-BOOK OF MATERIA MEDIC A. 

protective inoculation may be regarded as useful for sheep, but for 
man no reliable serum is known. 

Rabies. — In January, 1881, Galtier announced that intravenous 
inoculation of rabid saliva confers immunity upon sheep, confirm- 
ing his experiments later in the year by injecting the fluid into nine 
sheep and one goat. Pasteur, Chamberland, Roux, and Thuiller 
pursued experiments in a similar line, with somewhat negative 
results. 

By passing the virus successively from dogs to monkeys, Pasteur 
was able to attenuate its virulence, and finally, by transferring the 
poison from monkeys to rabbits, a serviceable immunizing agent 
was obtained, still further experiments perfecting the method in 
view. 

Satisfied with his success, Pasteur now turned his attention to 
the inoculation of man against hydrophobia. The first operation 
(in 1885) was attended with auspicious results, and from that 
moment the savant's laboratory was invaded by affected individuals 
demanding cure. Institutes were founded in various parts of the 
world, that in Paris being the center of bacteriological study in 
France. In America the subject has received wide attention, but 
in many instances the benefits derived from Pasteur's inoculative 
procedure have been held to be of doubtful importance by intelli- 
gent observers. 

Pasteur's treatment of hydrophobia is based on the fact that 
rabic virus may be intensified or attenuated at will. If successive 
inoculations be made into rabbits with fluid taken either from the 
dog or the monkey, the virulence may be so increased above that 
of a street-dog, requiring from twelve to fourteen days for incuba- 
tion, that after about one hundred inoculations the period of incu- 
bation may be reduced to seven or even six days. This, the most 
powerful virus yet attained, Pasteur termed virus fixe. When pro- 
tected from light and air this virus retains its strength for a long 
period. Pasteur further observed that the cords of rabbits which 
had been dead for some time contained a less virulent poison than 
those of animals freshly killed, especially when the air was dry and 
the cord protected from putrefactive influences, the most efficient 
inoculation being that of an emulsion made from cords exposed to 
dry air for ten and fourteen days, followed by emulsions of cords 
exposed for shorter periods. 

With regard to the administration of serum, several precautions 
are of great importance. The absolute cleanliness of the syringe, 
for example, should be an object of especial care. To this end a 
glass barrel is preferable, in order that impurities may be readily 
detected and removed. For packing purposes rubber or asbestos 
should be employed, and the instrument should be so constructed 
as to permit cleansing and sterilizing of every part before and after 
use. 

The mode of injection and the amount of dosage (measured in 
antitoxin units) vary somewhat according to the nature of the dis- 



ANIMAL EXTRACTS (ORGANOTHERAPY). 615 

ease and the age and susceptibility of the patient. Care should be 
taken to use only the most reliable preparations. 

It has been impossible to present within a necessarily limited 
space the entire field covered by this profoundly interesting subject. 
For a multitude of details, embodying a wide range of experimen- 
tation, and for many expressions of individual opinion awakened 
by a consideration of so-absorbing a theme, the student is referred 
to the extensive bibliography relating to every phase of serum- 
therapy. 

It may be readily imagined what would have been the discus- 
sion of Jenner's vaccination had our bacteriological and chemical 
knowledge and delicate appliances for investigation existed in his 
day. It is scarcely surprising, therefore, that the renewal of similar 
studies, after an interval of unprecedented scientific progress, should 
elicit from all parts of the world a zeal and enthusiasm impossible 
in any previous epoch, together with a mass of concurrent or dis- 
senting testimony touching new discoveries proportionate to the 
greatly increased number of competent investigators. Whatever be 
the limitations of serum-therapy, the consensus of opinion among 
thoughtful observers is that its importance to mankind and its pur- 
pose are deeply rooted in the eternal laws of matter and the 
methods of great Nature. Its rationale, its mysterious power, and 
startling phenomena awaken new and greater problems of bacterio- 
logical science ; yet, though the entire subject, embracing as it does 
so ample and momentous a field of inquiry, remains sub judice, the 
character of modern scientific investigation must surely reveal its 
truth or falsity. 



PRESCRIPTIONS, 



A prescription (L. prce, for ; scriba, I write) is an order on the 
pharmacist to furnish the patient a single remedy or a combination 
of remedies made into the form desired by the physician. All 
prescriptions are, then, simple if containing but one drug preparation, 
and compound if containing more than one. 

The first element of correctness in prescription-writing consists 
in so forming the prescription that the pharmacist will, without ques- 
tion, understand it as the physician does. Any chance of a wrong 
interpretation by the pharmacist must be carefully guarded against. 

The names of drugs in prescriptions are regularly written in 
Latin, the advantages of this being that they are without ambiguity, 
are readable in any part of the civilized world, and are not intelligible 
to the average patient, who frequently has erroneous preconceived 
notions of the efficacy of certain drugs. 

English names are often ambiguous, for example, the name 
" snake-root " is applied in different parts of the country to the 
plants Cimicifuga racemosa, Aristolochia serpentaria, Asarum Cana- 
dense, Eupatorium aromaticwn, Polygala Senega, etc. 

The parts of the ordinary prescription are : 

1. The name of the patient, and date. 

2. The symbol 1^ representing the Latin word recipe, take thou. 
This is known also as the superscription. 

3. The names and quantities of the ingredients, known also as the 
inscription. 

4. Directions to the pharmacist: What he is to do with the 
ingredients, whether to make them into pills or capsules or a plaster, 
etc. Known also as the subscription. 

5. Directions for the patient. To be placed by the pharmacist on 
the label. Known also as the signature. 

6. The signature of the physician. 
Example : 

For Mrs. B } July 3, 1899. 

I^ 2 * Olei morrhuae, lsiij ; ) 

Vini albi, £3j ; > s 

Glyceriti vitelli, q. s. ad fsviij ; J 
Fiat emulsio. 4 
Sig. Tablespoonful after meals. 5 



Dr. P- 



* In ancient times it was customary to preface a prescription with a pious invocation 
to Jupiter or some guardian deity. These prayers were finally abbreviated, until they 
came to be expressed by the simple astronomical sign Oj., symbol of the planet Jupiter. 
The upright stroke across the letter R heading modern prescriptions is a curious relic of 
the above heathen usage condensed in the planetary sign. 

616 



PRESCRIPTIONS. 617 

Here the small numerals or exponents are ( 1,z ) the superscrip- 
tion ; ( 3 ) the inscription ; ( 4 ) the subscription ; ( 5 ' 6 ) the signature. 

Formerly a typical prescription was said to consist of four 
divisions : 

1. The basis, or principle active agent. 

2. The adjuvant, or auxiliary, to aid the action of the basis ; 

3. The corrective, to correct or modify its action ; 

4. The vehicle, to give proper form or taste to the whole. 

But it is not necessary that all prescriptions shall include the 
above four divisions. 

Each ingredient should have a separate line. 

Combination of Drugs. 

In writing a prescription we assume that it is intended, as should 
always be the case, to fulfil a single therapeutic purpose only ; and 
we are to decide first, whether the medicine shall be administered 
in a solid or in a liquid form ; and second, whether a single remedy 
or a combination of remedies shall be prescribed. 

The tendency to-day, among many able therapeutists and clini- 
cians, is to prescribe single drugs or simple combinations, while the 
prescriptions of former times containing a large number of ingredients, 
the so-called " shot-gun " prescriptions, are good examples of 
polypharmacy. There is, however, danger in going to the extreme 
of sacrificing therapeutic efficiency to simplicity of form and elegant 
pharmacy ; and it must be confessed that such compounds as 
Warburg's tincture and the bolus prescribed by Dr. Graves in the 
treatment of dropsical patients prove the efficacy of polypharmacy 
in many cases. 

As a general rule, we prescribe only one drug to provoke emesis, 
and a combination of several if we wish a diuretic. A purgative is 
usually multiple, but if the selection be castor oil or croton oil, it 
will be single. 

• After we have selected the basis, or chief ingredient or ingredients, 
of our prescription, the next point to determine is whether we can 
add anything which will in any manner be of real assistance to that 
basis. This ingredient, or adjuvant — as it is called — has usually a 
physiological action similar to that produced by the basis, as in 
combining two cathartics or two diuretics to act upon different 
portions of the intestines or kidneys. Sometimes, however, an 
adjuvant may differ in its effects — as sulphuric acid serves as an 
adjuvant to quinine by favoring its absorption and thereby hasten- 
ing and increasing its action, as mercury assists the action of squills 
upon the kidneys, or as iron is an adjuvant to a cardiac stimulant. 

Having chosen the adjuvant, the next point to consider is 
whether the action of the drugs selected may not be rendered more 
kindly through the addition of some other substance as a corrective — 
that is, to correct some disagreeable effect of the active agents. 
For example, extract of belladonna or hyoscyamus relieves the griping 



618 A TEXT-BOOK OF MATERIA MEDICA. 

occasioned by some of the more violent cathartics, like podophyllin. 
Other well-known instances of this kind are those of the aromatic 
spirit of ammonia, which mitigates the unpleasant symptoms of 
iodism, and hydrobromic acid, which lessens the untoward action of 
quinine. 

Great care and thought should be given not only to the basis, 
adjuvant, and corrective, but also to the vehicle, which claims 
equal attention. The vehicle is the diluent, generally employed to 
make up the quantity to a definite number of easily measured doses. 
It may be a substance with a pleasant flavor or aroma, for a pre- 
scription is often rendered more palatable, and no less efficient, by 
some substance which produces a more agreeable taste. It is a 
mistaken idea that medicines, in order to be effective, should be 
repulsive to the patient. The homeopath's success is largely due 
to the very agreeable taste of his remedies. The mere caprice of 
the patient, however, should not be considered in the choice of 
a remedy, when, in the best judgment of the physician, it is indicated. 
Still, it is well to study carefully the art of prescribing agreeable 
doses, so far as may be compatible with fidelity to science. It is to 
be noted that pleasantness of taste is far more important in the case 
of fluids than in that of solids. 

The favorite vehicles are : The aromatic waters, such as anise, 
cinnamon, peppermint, rose, etc. ; the aromatic syrups, orange, 
orange flowers and tolu ; the elixirs, fluidextract of licorice, etc. 
Some patients dislike sweet mixtures. In many cases simple 
syrup, glycerin or pure water serves, after all, as the best vehicle, 
although the physician's choice must be governed mainly by ex- 
perience. 

Other things being equal, a liquid is more rapidly absorbed 
than a solid preparation ; but for exact dosage and convenience in 
carrying about, pills, capsules, tablets, and powders are favorite forms 
of administration. These should usually be given with plenty of 
water to aid disintegration, or to insure their solution or dilution. 
Many substances administered in pill, tablet, or capsule form will 
be very irritating to the stomach if given without water, or may fail 
to disintegrate so that they are passed in the stools unchanged. 
Tablets with strong irritating properties, like potassium iodide, 
potassium bromide, or ammonium chloride, should be dissolved in 
water before administration. 

The bitter taste of a remedy may be avoided by administering 
the drug in capsules, or cachets, or as sugar-coated or gelatine- 
coated pills ; or, if a liquid, by adding syrup of yerba santa or vari- 
ous aromatic or sweetened liquids. 

Prof. H. C. Wood, M. D., has written so clearly upon the art of 
combining, or, more correctly speaking, associating, medicines that 
we cannot do better than quote his observations verbatim: 

" The art of combining medicines is not a difficult one, but in 
practice certain principles should not be lost sight of. Chief of 
these are, to prescribe as few remedies as possible, and to use no 



PRESCRIPTIONS. 619 

powerful drug without a very distinct idea of what it is intended to 
do. Whenever it is desired to give a powerful remedy in increasing 
doses until its physiological effect is produced, it should always be 
given by itself. Thus, it may be necessary to give arsenic so as to 
impress the system, at the same time that iron is indicated ; but the 
two remedies should be given separately, so that the dose of either 
can be increased or diminished independently of the other." 

The principles of combination formulated below were long ago 
enunciated by Dr. Paris, but are to-day as imperative as ever. 
Medicines are combined : 

"First. To augment, correct, or modify the action of a medicine. 
Thus, purgatives act much more kindly when a number of them 
are united together. The chief reason of this probably is that, as 
different remedies affect different portions of the gut, the whole 
intestine is best reached by a union of the diverse substances. It 
may take an intense irritation of the mucous membrane to purge 
as actively as does a mild irritation of both the mucous membrane 
and the muscular coat. 

" There are powerful medicines which act similarly upon some 
parts of the organism, but dissimilarly upon other parts. By com- 
bining such powerful remedies effects can be obtained at the points 
where the two lines of action cross each other, without influencing 
to a great extent other portions of the system. Thus, chloral pro- 
duces sleep by its action upon the brain, and also has a distinct 
influence upon the heart, but none upon the intestinal tract. Mor- 
phine acts upon the brain, and does not influence the heart, but has 
a powerful effect upon the intestinal tract. By combining chloral 
and morphine we get an overwhelming conjoined influence upon 
the brain in producing sleep, with the least possible disturbance of 
the heart and of the intestinal tract. 

" Second. To obtain the joint action of two or more diverse reme- 
dies. Thus, in a cough-mixture, morphine may be included to quiet 
the cough, whilst ipecacuanha and squill (in accordance with the 
first principle) are added to affect the mucous membrane. The 
application of this principle requires caution, or the practitioner will 
be led into that chief abomination — polypharmacy. It is worse than 
futile to attempt to prescribe for every symptom. It is the under- 
lying cause of the disorder, or the under-stratum of bodily condi- 
tion, which must be sought out and prescribed for simply. 

" Third. To obtain a special combination which is really a new 
remedy, or which experience has shown acts almost as a new 
remedy. Thus, when to potassium iodide in solution corrosive 
sublimate is added, a new chemical compound (potassio-mercuric 
iodide) is formed, which experience has shown to be of great value 
in syphilitic diseases. Griffith's antihectic mixture (mistura ferri 
comp.) is another instance of the use of chemical changes, the 
protocarbonate of iron (ferrous carbonate) being formed out of the 
sulphate of the metal and the potassium carbonate. In the famous 
Dover's powder no chemical change occurs, but the ordinary action 



620 A TEXT-BOOK OF MA TERIA MEDICA. 

of opium upon the skin is so enhanced by the ipecac that the com- 
bination may be looked upon almost as a new remedy. 

" Fourth. To afford a suitable form. Thus, acacia is added to 
make an emulsion, or confection of rose to make a pill. In the 
choice of excipients care should be exercised to select a substance 
free from medicinal properties, having no chemical incompatibility 
with the medicinal agent and of suitable physical character. Bread- 
crumb often makes a good excipient for pills, but with silver nitrate 
it is chemically incompatible, on account of the sodium chloride it 
contains. 

" When writing a prescription the utmost care should be taken 
to use such excipients that the combination should not only be 
attractive to the eye, but also as little repulsive to the palate as 
may be. Whenever possible the pill form should be employed 
with bitter or disagreeable medicines. The pill may be readily 
coated with silver-foil ; tonic pills may be coated with iron by 
shaking or rolling them in ferri pulvis while soft and sticky. 
Sugar-coated pills and ' compressed pills ' are apt to get so hard 
and insoluble that their use requires caution. In regard to mixtures, 
flavoring oils should be freely used, and the power of glycerin to 
conceal the disagreeable taste of many substances should be 
remembered." * 

INCOMPATIBILITY. 

When different substances, whether liquid or solid, are com- 
bined or associated and undergo a more or less complete change, 
they are said to be incompatible, the incompatibility consisting of 
two kinds : chemical and pharmaceutical. (Drugs that are opposed 
in their physiological action are preferably spoken of as antagonists)) 

The incompatibles and antagonists of the different substances 
are fully mentioned under the respective drugs. The principles 
governing incompatibility, however, may well be considered here. 

Chemical incompatibility is of the most importance. 

The commonest forms of chemical incompatibility occur under 
the following conditions : 

i. When a new and insoluble salt is formed, resulting from a 
mixture of solutions of soluble salts. Example (i) : mixing solu- 
tions of lead acetate and zinc sulphate, both soluble salts, but pro- 
ducing by chemical decomposition a new and insoluble salt, the 
sulphate of lead; which is precipitated. 

2. By the addition of a strong acid to solutions of salts of 
weak or volatile acids, such as carbonates and bicarbonates, with 
resulting decomposition. Example (2) : ammonium carbonate, the 
salt of a weak acid radical, added to syrup of squills, containing 
acetic acid, causes decomposition to take place, with effervescence 
and the liberation of carbonic-acid gas. 

3. Salts of a feeble or volatile base are decomposed by the 

1 Therapeutics t 7th ed., pp. 108 et sea. 



PRESCRIPTIONS. 621 

addition of a strong alkali. Example (3) : the evolution of ammonia 
when a strong alkali is added to ammonia alum, and when chloral 
hydrate is decomposed by alkalies, such as aromatic spirit of 
ammonia, lime solution, etc. 

4. Alkaloids, or their salts, are thrown out of solution or pre- 
cipitated from their solutions by the addition of alkalies or alkaline 
salts. Example (4) : sulphate of strychnine in solution is precipitated 
as the insoluble bromide of strychnine by the addition of a larger 
proportion of potassium bromide. Quinine sulphate is precipitated 
as insoluble quinine acetate when mixed with a solution of potas- 
sium acetate. 

5. Tannic and gallic acids and preparations containing them, 
as well as many other vegetable acids, produce discoloration or 
precipitation of iron and many of its compounds. Example (5) : ink 
is the best illustration of this incompatibility. Writing fluids are 
usually combinations of tannic or gallic acid with some preparation 
of iron. Add the tincture of ferric chloride to tincture of cinchona, 
and notice the discoloration. 

There are certain preparations of iron, like the compounds with 
ammonium or sodium citrate (see Tincture Ferri Citro-chloride, N. F., 
tasteless tincture of iron) which produce little discoloration with 
vegetable astringents, and none at all with vegetable preparations 
containing no tannic or gallic acid. 

Pharmaceutical incompatibility is the production of a sediment 
by change of solvent without chemical action. Examples : vege- 
table tinctures of resinous drugs with water, such as tincture of 
guaiac and water ; copaiba and oils with aqueous preparations ; 
spirit of camphor with water ; spirit of nitrous ether with mucilage 
of acacia, etc. The separation or precipitation may frequently be 
prevented by the intervention of some viscid substance, such as 
syrup, glucose, glycerin, mucilage of acacia, etc. 

The following is a reference-list of the common incompatibles 
of individual drugs : 

Substance. Incompatible with 

Acacia Alcohol, tinctures ; borax ; ferric chloride ; lead salts. 

Acids in general .... Alkalies ; metallic oxides, carbonates, and halogen salts. 
Acid : 

Arsenous Ferric hydroxide ; magnesia ; lime water. 

Chromic. .... Organic substances (alcohol, etc.). 

Salicylic Iron compounds. 

{Alkalies, carbonates, and bicarbonates ; lime water ; chlorine 
water; albumin; gelatin; alkaloids; salts of heavy 
metals; iron salts. 
Bismuth : 

, .. . f Calomel *; sulphur ; tannin ; sodium bicarbonate ( slow evolu- 

bubnitrate . . . < ,. V n X -r ■ .\ v 

( tion of C0 2 gas if moist). 

Chloral : 

u , f Alkalies, carbonates * ; ammonium and mercury compounds ; 

y * * * * \ potassium bromide; alcohol. 

T ,. f Ammonia*; alkalies*, carbonates; chloral; metallic salts: 

Jodme { starch*. 



622 A TEXT-BOOK OF MATERIA MEDICA. 

Substance. Incompatible with 



Lead : 

Acetate 



Mercury : 

Bichloride 



f Acacia; acid hydrochloric; acid sulphuric and sulphates; 

alum * ; ammonium chloride ; carbonates ; lime water ; 

iodine ; potassium iodide ; sulphides ; tannin : zinc sul- 
[ phate *. 



f Potassium iodide * ; salts, carbonates ; tannin ; borax ; alka- 
li loids ; lime water *. 
Acids, acid salts; alkalies, carbonates; lime water* ; ammo- 
nium chloride ; iodine ; potassium iodide ; ferric chloride, 
iodide ; soap ; sulphur. 



Mild Chloride 
(Calomel) 

Potassium : 

Chlorate Acids, mineral ; calomel ; organic substances ; sulphur. 

, ... j Acids, acid salts; alkaloids; iron; lead and mercury salts; 

' \ potassium chlorate ; silver nitrate ; chlorine water. 

( Ammonia, salts ; organic substances ; alcohol ; glycerin ; 
I ethereal oils. 



Permanganate 
Sodium : 

Bicarbonate . 



f Acids, acid salts; alkaloids; bismuth subnitrate; calomel; 
\ metallic salts. 

Bromide Acids, mineral ; chlorine water ; mercury compounds. 

Silver : 

{All organic substances (alcohol, glycerin, extracts, oils, starch, 
etc.); chlorides, bromides, iodides; alkalies; acids, 
hydrochloric and sulphuric. 

Those marked with a * are sometimes directed to be compounded for the purpose 
of effecting some special change or producing new compounds. 

Among the above, potassium permanganate forms an explosive 
mixture with glycerin ; so does chromic acid. Chlorates of potas- 
sium, etc., explode when triturated with sulphur, tannic acid, or even 
particles of cork. The strong acids, nitric and sulphuric acids, and 
especially mixtures of these, react so strongly with volatile oils 
(hydrocarbons) as to cause explosion. Iodine affects these oils in 
the same way — fulminates. 

It not infrequently happens that the physician intentionally 
writes a chemically incompatible prescription. " Black wash " 
(calomel and lime-water), and " yellow wash " (mercuric bichloride 
and lime-water) are examples. Other instances are such pharma- 
copoeial preparations as liquor ammonii acetatis, mistura ferri com- 
posita, liquor magnesii citratis, and Blaud's pills. 

ANTAGONISM. 

Antagonists are drugs which are opposed to each other in their 
physiological effects. 

Antagonism was formerly known as "therapeutic incompati- 
bility," but, as this latter term has led to confusion, it is now thought 
best to limit the term " incompatibility " to chemical and physical 
changes, such as may occur in a prescription, and to give the term 
"antagonism" to physiological opposition. 

Xo general rule can be laid down for the avoidance of antag- 
onism. Some of our most valuable drugs contain active principles 
which are physiologically opposed to each other in their action ; 



PRESCRIPTIONS. 623 

instance : jaborandi, which contains two absolutely antagonistic 
alkaloids, pilocarpine and jaborine, the latter in small quantity, yet 
sufficient to control the action of the former. 

Opium is a conspicuous example of a complex remedy, con- 
taining, besides gum, sugar, etc., eighteen different alkaloids, two 
neutral principles, and two peculiar acids ; so that a prescriber of 
this drug, while he may, perhaps, flatter himself that he is con- 
forming strictly to the present notions of pharmaceutical simplicity, 
is in effect a polypharmacist of most pronounced type. Moreover, 
not only are the constituents of opium very numerous, but, like 
others mentioned, the drug affords in its thebaine and morphine 
a further illustration of direct physiological antagonism. 

Again, physiological antagonists are often given together, as 
atropine and morphine, or aconite and digitalis in certain cases of 
cardiac arrhythmia. 

The author cannot too strongly recommend that physicians 
ignorant of the physiological action of drugs in large and small 
doses, if they prescribe at all, should avoid including many reme- 
dies in one prescription. But, given a competent and thorough 
knowledge of the action of drugs and the exact condition of the 
patient, the physician is justified in giving one or twenty drugs in 
the same prescription, since he is perfectly familiar with the several 
agents of relief, and can foretell with nicety the effect to be pro- 
duced by their combination. In all cases a physician should be as 
certain of the action and strength of the preparations he administers 
as the surgeon of the aseptic condition of his hands and instruments. 

ESTIMATION OF AMOUNTS. 

Having decided upon the various ingredients which are to enter 
into the prescription, the next consideration is the desirable amount 
of each. 

The bottles found in pharmacies have capacities of 1,2, and 4 
fluidrams, and 1, 2, 3, 4, 6, 8, 12, 16, and 32 fluidounces, or 4, 8, 
15, 30, 60, 90, 120, 240, 500, and 1000 Cc, and it is wise to pre- 
scribe mixtures of these sizes ; otherwise, the patient may fear some 
error from receiving a bottle only partly full, as when a 10-ounce 
mixture is placed in a 12-ounce bottle. 

As a rule, it is better to prescribe small bottles rather than large. 
Always avoid ordering more of a medicine than the patient will 
probably need. 

Having decided, then, how many doses to order, and the dose 
of each ingredient, it is a simple matter of multiplication to figure 
how much of each ingredient shall go in the prescription. 

The following is a very simple rule for estimating amounts in 
Apothecaries' Measure : 

In an eight-ounce mixture, the dose being a dram, take as many 
drams of the medicine as there are wanted minims or grains to the 
dose. It will be observed that in this case the basis is an eight- 



624 A TEXT-BOOK OF MA TERIA MEDICA. 

ounce mixture, yet it typifies the rule which, when thoroughly 
understood, may easily be applied to a four-ounce or a two-ounce 
mixture, one-half or one-fourth as many drams ; while if the dose 
is to be a dessertspoonful, or two drams, it is only necessary to 
take one-half as many drams to an eight-ounce mixture, reducing 
for smaller mixtures in accordance with the rule. If the dose be a 
tablespoonful, or four drams, one-fourth as many drams must be 
taken to an eight-ounce mixture as there are minims or grains to 
the dose. This rule, while not fractionally exact, is sufficiently 
accurate for all practical purposes. 

Examples : We desire to give an eight-ounce mixture, with a 
dram for a dose, each dose to contain 12 grains of potassium 
bromide and 10 grains of chloral, the vehicle to be syrup of orange 
and water. We have here, then, 64 doses of a dram each : to be 
exact, therefore, we should have 768 grains of potassium bromide, 
or 12 drams and 48 grains ; but, following the rule, we put in the 
mixture 12 drams, since we desire 12 grains to the dose. Of chloral 
we would require exactly 640 grains, or 10 drams and 40 grains, but 
we use the round number, 10 drams, in the mixture. We see that 
in each case there is but the fraction of a grain short in the dose. 

The prescription would consequently be written as follows : 

1^. Potassii bromidi, 3xij ; 

Chloralis, £x ; 

Syrupi aurantii, ^iv ; 

Aquae, q. s. ad Bviij. 

M. et. Sig. — Teaspoonful for a dose. 

Or, if we wish the medicaments in greater dilution, we may halve 
the amounts and double the dose, as follows : 

3^. Potassii bromidi, 3yj ; 

Chloralis, 3v ; 

Syrupi aurantii, ^iv ; 

Aquae, q. s. ad 3viij. 

M. et. ft. sol. Sig. — A dessertspoonful for a dose. 

The amount of each ingredient thus varies with the size of the 
mixture, and inversely as the dose — i. e., the larger the mixture the 
greater the amount of the ingredients, the dose being the same ; 
and, the larger the dose the smaller the amount of the ingredients, 
the size of the mixture remaining the same. 

When writing a prescription put down first all the ingredients 
which are to enter into the combination, and, after the last one, 
which is usually the vehicle, write the whole amount — i, e., if it is 
to be a four-ounce mixture, write after the name of the vehicle 
" q. s. ad §iv." Then figure the total amount for each ingredient, 
by multiplying the amount of each dose by the number of doses, 
and write it down. In other words, decide upon the doses to be 
given after the medicines have been selected. 

The next thing to be determined is the manner in which the 



PRESCRIPTIONS. 625 

medicine should be measured out to the patient for internal use. 
A graduated medicine-glass is always preferable to a domestic 
measure, and should be ordered in all cases. Teaspoons, as 
well as dessertspoons and tablespoons, vary considerably in size. 
A teaspoonful, considered to be equivalent to one fluidram, may 
contain from one-half to two fluidrams ; a dessertspoonful, which 
should be equivalent to two fluidrams, and a tablespoonful, equal 
to one-half fluidounce, vary almost as much in capacity. 

Ordinarily, it is unwise to prescribe medicines to be dropped 
out, since a drop varies greatly in dimension according to the vis- 
cosity and specific gravity of the fluid, the shape, size, and charac- 
ter of the neck and lip of the bottle, the degree of fulness of the 
bottle, and the steadiness of the hand in dropping. 

Drops, therefore, are not accurate measures. Sometimes, how- 
ever, it is desirable to order medicines in drops, and then it is well 
to remember that aqueous liquids and fixed oils drop about one 
drop to the minim, and volatile oils and alcoholic liquids, such as 
tinctures or fluidextracts, drop about two drops to the minim. 

There are exactly 60 minims of any fluid in 1 fluidram, while 
60 drops may be greater or less than 1 fluidram, as the following 
list shows : 

Drops in foj Weights of f5j 

(60 M.) Gr. Gm. 

Acidum carbolicum in 59 3-^ 2 

Acidum sulphuricum aromaticum .... 146 53 3.43 

^ther fortior 176 39 2.52 

Chloroformum purificatum 250 80 5.18 

Creosotum 122 56^ 3.66 

Fluidextractum belladonnas 156 57 3.69 

Fluidextractum colchici radicis 160 55 3.56 

Fluidextractum digitalis 134 62 4.01 

Liq. iodi compositus 63 59 3.82 

Liq. potassii arsenitis 57 55 3-5^ 

Oleum caryophylli 130 57 3-^9 

Oleum tiglii 104 50 3.24 

Spiritus ammonias aromaticus 14 2 4-8 3- 11 

Syrupus ferri iodidi ' . 65 77 4.98 

Syrupus scillae compositus 102 70 4.53 

Tinctura aconiti H 6 4 6 2 -9% 

Tinctura belladonna? ■ l 37 53 3-43 

Tinctura cantharidis 13 1 5 1 3-33 

Tinctura ferri chloridi 150 53 3.43 

Tinctura nucis vomicae 14° 44 2 -&5 

Tinctura opii 13° 53 3-43 

Tinctura veratri 145 4 6 2 -9 8 

Vimim colchici seminis in 54 3-49 

LANGUAGE AND GRAMMATICAL CONSTRUCTION 
OF PRESCRIPTIONS. 

A prescription is written partly in Latin, partly in English. The 
name of the patient and the date should be in English ; the super- 
scription in Latin abbreviation ; the ingredients in Latin ; the direc- 
tions to the pharmacist in Latin or Latin abbreviations ; and the 
directions to the patient in English or Latin. 

40 



626 A TEXT-BOOK OF MATERIA MEDICA. 

A prescription properly and unmistakably written is a cardinal 
requisite to the successful administration of medicine, no less than 
to its correct preparation by the druggist. The reasons for the 
employment of Latin in prescriptions have already been given, and 
it is well for every practitioner and pharmacist to possess some 
knowledge of Latin grammar. Still, by the observance of a few 
simple rules, one wholly ignorant of the language may acquire a 
proper use of the forms generally adopted ; and a little study, aided 
by constant practice, will soon fix in the memory the peculiarities 
of gender, case, and number, and the agreement of adjectives, to be 
met with in all prescriptions. 

VERBS. 

The imperative singular is employed in the superscription Tfy — 
i. e. y recipe, "take (thou)," and in certain directions to the pharma- 
cist, as misce, "mix"; divide, "divide"; fac t "make"; solve, "dis- 
solve "; etc. 

The subjunctive mood, having the force of the imperative, is 
also used, as quantum sujficiat, " as much as may suffice"; fiat,fiant, 
" let be made " (as fiat mistura, " let a mixture be made," or jiant in 
pilulas, " let the ingredients be put into pills ") ; bidliat, " let it boil " ; 
ne repetatur, " do not let it be repeated," " do not repeat "; dividen- 
dur, " let them be divided," etc. 

A future passive participle is also frequently used : dividendus, 
like an adjective agreeing with the noun in gender, case, and num- 
ber, and signifying " to be divided (into)," as in the order in tro- 
chiscos dividenda (massa), " to be divided into troches." 

NOUNS. 

Latin nouns are declined according to five different plans, and 
these are known as the five declensions. Four cases are used in 
prescription-writing : nominative, genitive, accusative, and ablative. 

Most nouns ending in a are of the first declension, are feminine, 
and are declined as follows : 

Singular. 



Nominative — Oliva 


— 


Olive (subject' 


Genitive — Ollvae 


— 


of Olive. 


Accusative — Olivam 


— 


Olive (object). 


Ablative — Oliva 


— 


with Olive. 


Plural 






Nom. — Oliva? — 


Oli 


!ves (subject). 


Gen. — Olivarum — 


of Olives. 


Ace. — Olivas — 


Oli 


ves (object). 


Abl. — Olivis — 


with Olives. 



PRESCRIPTIONS. 627 

An exception is Aloe : 

Nom. — Aloe. 
Gen. — Aloes. 
Ace. — Aloen. 
Abl. — Aloe. 

[The Latin dative and vocative cases are never used.] 

Medical nouns of the second declension end in us, os (masculine, 
except juniperus, prunus, sambucus, and ulmus, which are femi- 
nine), or um t on (neuter), as : 

Singular. Plural. 

Nom. — Oleum — Oil (subject). Olea — Oils (subject). 

Gen. — Olei — of Oil. Oleorum, Oleum — of Oils. 

Ace. — Oleum — Oil (object). Olea — Oils (object). 

Abl. — Oleo — with Oil. Oleis — with Oils. 

[The genders of nouns are given as a guide to the agreement of adjectives.] 

Or Nom. — Juniperus. 

Gen. — Juniperi. 

Ace. — Juniperum. 

Abl. — Junipero, etc. 

Indeed, all prescription nouns ending in us are of the second 
declension, save seven — rhus, rhois (3d fern.) and the six names 
of the fourth declension (see p. 629). 

The third declension does not follow such strict rules as do the 
others, and its endings are variously modified in their attachments 
to the root. These modifications are not indicated in the nomina- 
tive, but are expressed in the genitive, so the nominative and geni- 
tive should always be learned together. It should be observed 
that, no matter what the connecting-links between the roots and 
the endings may be, the latter are always the same, viz. : in the 
singular, gen. is, ace. em, abl. e or i ; in the plural, nom. es or a, 
gen. um, ace. es or a, abl. ibus. The nouns of the third declen- 
sion may be grouped as follows : 

Group I. — Thirty-three nouns ending in as make the genitive 
in atis. All are masculine, save Asclepias (Gen. Asclepladis), which 
is feminine, and all are names of salts. Example : 

Singular. 

Nom. — Nltras. 
Gen. — Nitratis. 
Ace. — Nitratem. 
Abl. — Nitrate, etc. 



628 A TEXT-BOOK OF MATERIA MEDIC A. 

Group II. — 

Nouns ending in is : 
id) Genitive unchanged ; all feminine. 

Ex. Nom. Cannabis ; Gen. Cannabis. 
(b) Genitive changing into itis, all masculine. 
Ex. Nom. Arsenis ; Gen. Arsenitis. 
' (c) Genitive changing into idis, all feminine. 

Ex. Nom. Hamamelis ; Gen. Hamamelidis. 
(d) Genitive changing into eris, one only, masculine. 
Ex. Nom. Pulvis ; Gen. Pulveris, 

Group III. — 

Nouns ending in o, all feminine except Carbo, Pepo, and 
Sapo, which are masculine : 

(a) Genitive ending in anis. 

Ex. Nom. Lotio ; Gen. Lotionis. 

(b) Genitive ending in mis. 

Ex. Nom. Mucilago ; Gen. Mucilaginis. 

Group IV. — 

Nouns ending in x, masculine or feminine : . 

(a) Genitive ending in els. 

Ex. Nom. Borax; Gen. Boracis. 

(b) Genitive ending in els, and the last vowel of the nomina- 

tive (e) changed to i. 
Ex. Nom. Rum^x; Gen. Rum^'cis. 

Group V. — 

Nouns ending in r, masculine or neuter : 
Genitive simply adds Is. 

Ex. Nom. Liquor ; Gen. Liquoris. 

Group VI. — 

Nouns ending in a, all neuter : 
Genitive ends in dtis. 

Ex. Nom. Enema ; Gen. Enematis. 

Group VII. — 

Nouns ending in s, masculine or feminine: 
Genitive ends in Is. 

Ex. Nom. Adeps ; Gen. Adipis. 

Group VIII. — 

Nouns ending in /, all neuter.: 



PRESCRIPTIONS. 629 

{a) Genitive simply adds is. 

Ex. Nom. Chloral; Gen. Chloralis. 
(b) Genitive doubles / and adds Is. 

Ex. Nom. Mel; Gen. Mellis. 

Group IX. — 

Nouns ending in n, all neuter : 

(a) Genitive ending in onis (nominative in on). 

Ex. Nom. Limon ; Gen. Limonis. 

(b) Genitive ending in inis (nominative in en). 

Ex. Nom. Semen ; Gen. Seminis. 
[Erigeron has the genitive Erigerontis.] 

Group X. — 

One noun ending in c, neuter : 
Genitive simply adds is. 

Ex. Nom. Lac ; Gen. Lactis. 

Group XI. 

One noun ending in us, feminine : nom. rhus ; gen. rhois. 

There are only six medical nouns of the fourth declension, 
cornus and quercus (feminine), and fructus, haustus, potus and 
spiritus (masculine). They are declined as follows : 



Singular. Plural. 

Nom. — Spiritus. Spiritus. 

Gen. — Spiritus. Spiritum. 

Ace. — Spiritum, Spiritus. 

Abl. — Spiritu. Spintibus. 

Of the fifth declension we use the ablative die of the noun dies, 
a day, as in the expression ter in die " three times a day." 

The following nouns are usually considered indeclinable : Az- 
edarach, buchu, catechu, condurango, curare, cusso, diachylon, 
eriodictyon, jaborandi, kino, matico, quebracho, sago, and sassafras. 

ADJECTIVES. 

These are many and must agree in gender, number, and case 
with the nouns which they qualify. They are declined like nouns 
of different declensions, having the same cases and numbers, and 
may be divided into two classes. 

Class I. includes all but fourteen of the adjectives used in pre- 
scriptions. The nominative has three distinct endings : us, mascu- 
line, declined like the second declension of nouns ; a, feminine, de- 
clined like the first declension ; and um, neuter, declined like the 
second declension. Example : 



630 A TEXT-BOOK OF MATERIA MEDICA. 

Singular. 





(2d decl.) 


(1st decl.) 


(2d decl.) 




Masc. 


Fern. 


Neut. 


Nom. 


Fluidus, 


Fluida, 


Fluidum. 


Gen. 


Fluidi, 


Fluidse, 


Fluidi. 


Ace. 


Fluidum, 


Fluidam, 


Fluidum. 


Abl. 


Fluido, 


Fluida, 
Plural. 


Fluido. 


Nom. 


Fluidi, 


Fluidse, 


Fluida. 


Gen. 


Fluidorui 


n, Fluidarum 


, Fluidorum. 


Ace. 


Fluidos, 


Fluidas, 


Fluida. 


Abl. 


Fluidis, 


Fluidis, 


Fluidis. 



Class II. includes the remaining fourteen adjectives in use. 
These, with few exceptions, have two, instead of three endings : 
one in is for both masculine and feminine genders, and another 
in e for the neuter. Adjectives of this class are declined like nouns 
of the third declension. Example : 



Singular. 




Masc. and Fern. 


Neut. 


Nom. Dulcis, 


Dulce. 


Gen. Dulcis, 


Dulcis, 


Ace. Dulcem, 


Dulce. 


Abl. Dulci, 


Dulci. 



(The form Dulce is sometimes wrongly used for the ablative.) 







Plural. 




Nom. 


Dulces, 




Dulcia. 


Gen. 


Dulcium, 




Dulcium. 


Ace. 


Dulces, 




Dulcia. 


Abl. 


Dulcibus, 




Dulcibus. 



The exceptions in nominative endings are- 



PRESCRIPTIONS. 



6 3 J 







Singular. 








Masc. and Fern. 


Neut. 


(I) 


Norn. 


Effervescens, 


Effervescens. 




Gen. 


Effervescentis, 


Effervescentis. 




Ace. 


Effervescentem, 


Effervescens. 




Abl. 


Effervescente, or -i 
Plural. 


, Effervescente, or i. 




Nom. 


Effervescentes, 


Effervescentia. 




Gen. 


Effervescentium, 


Effervescentium. 




Ace. 


Effervesc6nt.es, 


Effervescentia. 




Abl. 


Effervescentibus, 
Singular. 


Effervescentibus. 


(2) 


Nom. 


Tricolor, 


Tricolor. 




Gen. 


Tricoloris, 


Tricoloris. 




Ace. 


Tricolorem, 


Tricolor. 




Abl. 


Tricolore, or -i, 
Plural. 


Tricolore, or -i. 




Nom. 


Tricolores, 


Tricolora. 




Gen. 


Tricolorum, 


Tricolorum. 




Ace. 


Tricolores, 


Tricolora. 




Abl. 


Tricoloribus, 

Singular. 


Tricoloribus. 






Masc. and Pern. 


Neut. 


(3) 


Nom. 


Fortior, 


Fortius. 




Gen. 


Fortioris, 


Fortioris. 




Ace. 


Fortiorem, 


Fortius. 




Abl. 


Fortiore, or -i, 


Fortiore, or -i. 



Plural. 

Nom. Fortiores, Fortiora. 

Gen. Fortiorum, Fortiorum. 

Ace. Fortiores, Fortiora. 

Abl. Fortioribus, Fortioribus. 



Numerals as far as quatuor are declined like adjectives of three 
terminations : 



6$2 



A TEXT-BOOK OF MA TERIA MEDICA. 







Singular. 






Masc. 


Fern. 


Neut. 


(i) Norn. 


Unus, 


Una, 


Unum. 


Gen. 


Unius, 


Unius, 


Unius. 


Ace. 


Unum, 


Unam, 


Unum. 


Abl. 


Uno, 


Una, 
Plural. 


Uno. 


(2) Norn. 


Duo, 


Duae, 


Duo. 


Gen. 


Duorum 


, Duarum, 


Duorum. 


Ace. 


Duos, 


Duas, 


Duo. 


Abl. 


Duobus, 


Duabus, 
Plural. 


Duobus. 




Masc. 


Fern. 


Neut. 


(3) Norn. 


Tres, 


Tres, 


Tria. 


Gen. 


Trium, 


Trium, 


Trium. 


Ace. 


Tres, 


Tres, 


Tria. 


Abl. 


Tribus, 


Tribus, 


Tribus. 



[The ordinal numbers, primus, secundus, tSrtius, etc., are not 
used in prescription-writing.] 

Conjunctions — Adverbs. 

Conjunctions are rare, except et, and. Adverbs are very seldom 
employed, except bene y well. 

Prepositions. ' . 

Three prepositions govern the accusative case : &d } to, up to ; 
In, into ; and supra, upon. Others are rarely used. 

Two prepositions, oftenest used, govern the ablative case : cictn, 
with, and pro, for. 



MUCH-USED WORDS AND PHRASES AND THEIR COMMON 
ABBREVIATIONS. 

Ad libitum (ad lib), at pleasure. 
Ad satur&ndum (ad sat.), to saturation. 
Ana (ad), of each. 
Bine, well, 



PRESCRIPTIONS. 633 

Bis, twice. 

Bis in die (b. i. d.), twice a day. 

Cibus, food. 

Cochleare medium (cochl. med.), a dessertspoon(ful). 

Cochleare magnum {cochl. mag:), a tablespoon(ful). 

Cochleare parvum [cochl. parv.), a teaspoon(ful). 

Collutorium (collut.), a mouth-wash. 

Dein, afterward. 

Dimldius, half. 

Dosus (dos.), a dose. 

Et, and. 

Extende supra, spread upon. 

Gradatim, gradually. 

Gutta (git.), a drop. 

Guttatim, drop by drop. 

Hora, an hour. 

In die, daily. 

Lagena, a bottle. 

Libra, a pound. 

Llnteum, lint. 

Mane, in the morning. 

Mane primo, early in the morning. 

Mica panis, a breadcrumb. 

iV<??z, not. 

Node, at night. 

Numerus, a number. 

Numero (No.), in number. 

Octavius (0.), a pint. 

Omne die (0. d.), every day. 

Omne mane (o. m.), every morning. 

Omne node (0. 71), every night. 

Partes czquales (part, aeq.), in equal parts. 

Pr£ r<? /z<2&2 (/>. r. /*.), as required. 

Quantum sufflciat (q. s.) as much as is necessary. 

Quaqua hora (q. h), every hour. 

Quaqua quattuor hora (q. q. h.) y every four hours. 

Saturatus, saturated. 

Sea tula (scat.), a box. 

Seme I, once. 

Semissis (ss.), a half. 

Semidrachma, (sss.), half a dram. 

Simul, together. 

Sine, without. 

Si opus sit (s. 0. s.), if necessary. 

Statim (stat.), immediately. 

Tales (tal.), such. 

Tales doses (dos. tal.), such doses. 

Tere simul, rub together. 

Ter in die (t. i. d.), three times a day. 



634 A TEXT-BOOK OF MATERIA MEDICA. 

These complete the list of Latin parts of speech, conjugations, 
declensions, etc., with which the prescription writer is likely to be 
concerned. 

We are now prepared to analyze a simple prescription and 
understand its elements. 

Suppose we wish the druggist to supply three drams of olive 
oil. We prescribe as follows : 

1^. Olei Ollvae giij. 

Recipe, Take of oil of olives three drams. 

It must be borne in mind that the direct object of the imperative 
recipe in this example, as well as in all similar cases, is not the 
word oleum, but the word drachmas representing the amount of it 
prescribed, as indicated by the Roman numerals and the symbol of 
Apothecaries' Weight, which, written in full, would be tres drachmas 
(ace). In this class of prescriptions, therefore, including nearly all 
in use, we need consider only the genitive, the accusative, or gram- 
matical object of the verb being expressed in the quantity symboli- 
cally indicated. 

It will be noted, moreover, that the construction, or order, of 
the Latin words is the reverse of English usage. Yet it is evi- 
dent that a grocer's clerk, for instance, might well, and frequently 
does, employ the same mode of expression : 

(of) Granulated Sugar, lbs. 10 — 

a construction precisely analogous to that of the above prescrip- 
tion, which simple form may be taken as a type for all, subject to 
such modifications as the nature of the drug and the treatment may 
require. 

There are niceties of Latin construction which, to one acquainted 
with that idiom, will readily occur in scanning the order of words in 
certain medicinal compounds. Having the sanction of professional 
usage, the departure from the classic arrangement is of slight 
importance, and it is certainly in accordance with the clearer, more 
direct, English form. Instance the construction in what are known 
as " Galenical Preparations " (an objectionable adjective, by the 
way, being at variance with the rules of etymology, since the c of 
the derivative is wanting in the parent word Galen). In writing 
these, the nominative — Unguentum, Mistura, Tinctura, etc. — is 
placed first, as, UnguCntum Zinci Oxidi, etc. Oleum Morrhuae 
is also an example, and others are not uncommon, apart from the 
Galenical order. 

The practical difficulties in writing prescriptions correctly are 
largely eliminated by the almost exclusive use of the genitive. Yet 
it is necessary to understand clearly the use of the accusative in all 
cases where the medicine is made into objects, as powders, cap- 
sules, etc. The names of such are the immediate object of the 
imperative recipe, and cannot be placed in the genitive. 



PRESCRIPTIONS. 635 

Example : 

1^. Pilulas (not Pilularum) Ferri Iodidi (No. xii). 

Where the mass is mentioned or implied in the prescription the 
general rule of the genitive is followed, as : Ify. Unguenti Bella- 
donnas (a portion) ; and where the terms flat, flant are expressed, 
the nominative is naturally used, as, for example, 

]^. Massas hydrargyri, gr. xxx ; 

Flant pilulae No. x. 
Sig. Take one at bedtime. 

Here pilulce is the subject of the Latin irregular verb signifying 
" to be made," no case save the nominative being admissible. We 
may, however, write " flat (or fiant) in pilulas No. x," the subject 
of the verb being the word for ingredient or ingredients (under- 
stood). 

It has been presumed in the foregoing pages that all prescrip- 
tions are to be written in full — a practice which, could it meet with 
universal acceptance, would not infrequently be of vital importance 
alike to patient and practitioner. Custom, however, — and in certain 
cases advantageously — has authorized the extensive use of abbrevia- 
tions, although the dangers of carelessness or ignorance in their 
employment will be apparent if we consider that, for example, 
Amnion, may mean either Ammonia or Ammoniacum ; Chlor., 
Chlorum, Chloral, Chloroformum, Chloras, or Chloridum ; Hyd. 
Chlor. y Hydrate of Chloral or Hydrargyri Chloridum Corrosivum 
or Mite ; Sulph., Sulphur, Sulphas, Sulphidum, or Sulphis ; Zinc. 
Phos., Zinci Phosphas or Zinci Phosphidum. 

These are but few of the many instances of ambiguity occa- 
sioned by inadvertence or want of familiarity with the full Latin 
form, or at least its recognized and unmistakable abbreviation. 

In conclusion, let the writer of prescriptions be warned against 
too great haste and a chirography which none but its author can 
decipher — a deficiency for which he alone is responsible, though 
the onus may fall upon the luckless druggist or his bewildered 
clerk. 

With regard to form, it has been our object to show that there 
is really little difficulty in writing good prescription Latin, and 
where the slightest chance of error exists the ample expression, as 
we have strongly urged, should be used. A clear, business-like 
method, deliberately chosen and consistently pursued, will render 
this important item of the physician's labor simple, agreeable, and 
efficient. 

It is wisest not only that the directions to the patients should 
be written in perfectly legible English and in full, but that they 
should contain the exact dose, time for, and method of taking, and, 
in short, every detail which may be advisable for the patient and 
nurse to know, clearly and intelligibly expressed. A physician is 



636 A TEXT-BOOK OF MATERIA MEDICA. 

seldom justified in writing merely " As directed," the full directions 
being the only clue to the safety of the medicine. Moreover, 
verbal instructions to the patient or attendent may be partially or 
even wholly forgotten, or confounded with directions relating to 
other matters connected with the case, and thus the welfare of the 
patient be endangered. 

The terms " For external use " or " Shake before using:" will 
be applied by the pharmacist as indicated by the character and use 
of the prescription, and need not be specified by the physician ; 
but the pharmacist never applies a " Poison " label to a prescription 
unless specifically directed to do so. 

Should it be necessary to prescribe an extraordinary dose of 
some powerful drug, the name of the remedy should be under- 
scored or attention called to it by a X, referring to the bottom of 
the prescription, where should be written : " Large dose intended," 
or " Dose of above correct," or something to indicate to the phar- 
macist that the writer is fully aware of the unusual amount, and 
thus save delay in consulting with the physician — which a careful 
and .competent druggist would otherwise do. Should it, in the 
opinion of the physician, be undesirable to repeat the prescription, he 
should write at the bottom, " Do not repeat," or the customary 
Latin, " Ne repetatur." 

In the case of a poor patient the letters P. P. after the name will 
insure the lowest price from the druggist. 

Every prescriber should be supplied with suitable prescription- 
blanks arranged in the form of pads conveniently carried in the 
pocket, a suitable size being four by five inches. The paper should 
be of linen, of good quality ; otherwise it is liable to become de- 
tached from the druggist's files and lost. A convenient form of 
pad is composed of prescription blanks with interleaves and copy- 
ing paper, so that the physician may always retain an exact record 
of the remedies ordered for his patient. 

It is certainly advisable for the physician to write his prescrip- 
tions invariably in ink, since pencil is easily erased, and a prescrip- 
tion thus perishable would be of little use in medicolegal emer- 
gencies. Besides, an unscrupulous druggist who had been careless 
in compounding the remedy might easily change the pencil instruc- 
tions to conform to his mistake. Finally, the pencil-writing is 
always liable to be erased or partially obliterated when carried for 
some time or subjected to frequent handling. 

The prescription-blank should have printed neatly upon one 
margin or the back the physician's residence and office, together 
with hours for consultation, and telephone number if he has one. 
This advertises the physician to some extent in a legitimate way, 
besides enabling the patient or druggist to communicate with him 
readily if necessary. 

The prescription should always be signed by the writer in full, 
that professional responsibility and identity may be assured, the 
academic " M. D." being preferable as a title to " Dr.," which is 



PRESCRIPTIONS. 637 

applicable to various professions — often of questionable repute and 
authenticity. 

In concluding these practical hints, the author cannot too 
strongly impress upon the student the importance of always writing 
as clear, legible, complete, and classical a prescription as possible. 
In a new community the reputation of the recent graduate is often 
dependent upon the character of the prescription he writes. The 
druggist invariably scans his instructions from the new doctor criti- 
cally, and the laity and the profession will soon learn the young 
aspirant's proficiency or ignorance by his public committal in a pre- 
scription. No matter how able a diagnostician, pathologist, or bac- 
teriologist he may be, if his first effort in prescription-writing be 
illegible, in poor Latin, or for a hopelessly incompatible mixture, the 
druggist will label, classify, and measure him with the keenness of 
professional insight ; the judgment will go forth quietly ; and years 
of successful practice may not serve to eradicate that first unfavor- 
able impression. 

It would be well to remember the following simple rules of good 
usage in prescription-writing : 

1. Solids are weighed, liquids measured. 

2. Very potent substances are placed first. 

3. Solids are written first in a liquid preparation, and liquids first 
in a solid preparation. 

4. Never employ " ditto " marks. 

5. Abbreviation is good usage (1) in the name of the kind of 
preparation, as elix. for elixir, tinct. for tinctura ; (2) in the direc- 
tions to the pharmacist ; (3) in certain well-recognized expressions 
in the directions to the patient (for example, t. i. d. for three times a 
day) ; but abbreviation is never allowable when there is possibility 
of ambiguity. 

If in doubt as to what is correct, write in plain English. 



GENERAL INDEX. 



Note. — The bold-face figures indicate the pages on which the drugs are treated 
in extenso. 



Absolute alcohol, 142 
Absorbent cotton, 136 
Acacia, 600 
Aceta, 96 
Acetal, 140, 164 
Acetanilid, 376 
Acetanilidum, 376 
Acetic acid, 483 

ether, 163 
Acetone, 176 

chloroform, 176 
Acetonum, 176 
Acetozone, 278 
Acetphenetidinum, 380 
Acetphenetidum, 380 
Acetum opii, 178 

scillae, 246 
Acetylene, 139 
Acid phosphates, 69 

wines, dry, 143 
Acids, 280, 450, 476 

aromatic, 304 
Acidulous waters, 474 
Acidum aceticum, 483 
dilutum, 483 
glaciale, 483, 592 

arsenosum, 389 

benzoicum, 305 

boricum, 487 

camphoricum, 359 

carbolicum, 289 

citricum, 483 

gallicum, 441 

hydriodicum dilutum, 466 

hydrobromicum dilutum, 194 

hydrochloricum, 477 

hydrochloridum dilutum, 477 

hydrocyanicum dilutum, 486 

hypophosphorosum, 387 
dilutum, 387 

lacticum, 482 

nitricum, 478 
dilutum, 478 

nitrohydrochloricum, 477, 478 
dilutum, 477, 478 

phosphoricum, 477 
dilutum, 477 

salicylicum, 308 

sulphuricum, 477 
aromaticum, 477 



Acidum sulphuricum dilutum, 478 

sulphurosum, 280 

tannicum, 439 

tartaricum, 484 

trichloraceticum, 592 
Aconite, 260 
Aconitina, 260 
Aconitine, 260 
Aconitum, 260 
Actol, 430 
Adeps benzoinatus, 304 

lanse, 598 
Adhesive plaster, 602 
Adipis lanae, 598 
Adjuvant elixirs, 80 
Adonidin, 247 
Adonin, 248 
Adonis vernalis, 247 
Adrenalin, 253 
Aerotherapy, 26 
^Ether, 154 
^ethylis carbamas, 165 

chloridum, 162 
Agathine, 375 
Agucarine, 585 
Aiodine, 605 
Airol, 286, 435 
Alcohol, 142 

absolutum. 142 

dilutum, 142 

halogen derivatives of, 169 

sulphur derivatives of, 167 
Alcoholic eye-wash, 74 
Alcoholism, acute, 147 
treatment of, 149* 

chronic, 148 

treatment of, 149 
Alcohols, 139 
Aldehydes, 140 
Ale, 143 _ 

Alexandria senna, 532 
Alkali solutions, 69 
Alkalies, 280, 450 
Alkaline salt solutions, 68 

waters, 474 
Allspice, 346 

Allyl isosulphocyanate, 322 
Almonds comp., 114 
Aloe, 527 

purifkata, 527 

639 



640 



GENERAL INDEX. 



Aloes, 527 
Aloin, 527 
Aloinum, 527 
Alphazone, 278 
Alsol, 431 
Alteratives, 382 
Althaea, 601 
Alum, 430 
Alumen, 430 

exsiccatum, 431 
Alumini hydroxidum, 431 

sulphas, 431 
Aluminium, 430 
Aluminum aceto-tartrate, 431 

boroformate, 431 

hydroxide, 431 

sulphate, 431 
Alumnol, 297, 431 
American hellebore, 263 
Aminoform, 568 
Ammonia liniment, 272 

spirit of, 272 

water, 272 
stronger, 272 
Ammoniated glycyrrhizin, 556 

mercury, 396 

tincture of guaiac, 583 
of valerian, 360 
Ammonii benzoas, 305 

bromidum, 194 

carbonas, 272, 457 

chloridum, 554 

iodidum, 466 

salicylas, 308 

valeras, 360 
Ammonio-ferric alum, 406 

sulphate, 406 

tartrate, 406 
Ammonioformaldehyde, 568 
Ammonium benzoate, 305 

bromide, 194, 197 

carbonate, 272, 457 

chloride, 554 

ichthyol, 303 

iodide, 466 

preparations of 272, 457 

salicylate, 308 

valerate, 360 
Amygdalin, 495 
Amyl,_ 139 

nitrite, 140, 268 
Amylene, 139 

hydrate, 139, 164 
Amy lis nitris, 268 
Amyloform, 315 
Amylolytic enzymes, 500 
Anaesthesin, 218 
Analgen, 367 
Analgesia, spinal, 217 
Analgesics, antipyretic, 364 
Analgine, 367 
Anchylostoma, 541 
Anemonin, 266 
Anesthetics, general, 153 



Anesthetics, local, 154 
Anethol, 330 
Anilines, 376 
Animal extracts, 604 
Anions, 33 
Anise, 330 

water, 330 
Anisi, 80 
Anisum, 330 
Antagonism, 622 
Antagonists, 620, 622 
Anthelmintics, 541 
Anthemis, 494 
Antidiabetin, 585 
Antidiphtheric serum, 610 
Antiemetics, local, 506 

systemic, 506 
Antifebrin, 376 

Antimonii et potassii tartras, 508 
Antimony and potassium tartrate, 508 
Antineuralgic pills, 122 
Antinosine, 286 
Antipyretic analgesics, 364 
Antipyretics, 364 
Antipyrina, 373 
Antipyrine, 373 ^ 
Antiseptic dressings, 136 

solution, 487 

solutions, 69 
Antiseptics, 276 

disinfecting power of, 281 
Antiseptol, 286, 367 
Antistreptococcic serum, 613 
Antithermine, 375 
Anyhydrous sodium arsenate, 390 
Apiol, 551 
Apiolum, 551 
Apolysin, 381 

Apomorphinae hydrochloridum, 507 
Apomorphine hydrochloride, 507 
Apothecaries' measure, 60 

rule for estimating amounts in, 623 

weight, 60 
Aqua ammoniae, 272 
fortior, 272 

anisi, 330 

camphorse, 359 

chloroformi, 159 

cinnamomi, 332 

creosoti, 299 

fceniculi, 333 

hamamelidis, 446 

hydrogenii dioxidi, 227 

menthae pipcritae, 339 
viridis, 340 

phagedaenica flava, 127 
nigra, 127 
Aquae medicatae, 67 
Arbutin, 348 
Argentamine, 430 
Argenti cyanidum, 426 

nitras, 426 
fusus, 427 
mitigatus, 426 



GENERAL INDEX. 



641 



Argenti oxidum, 427 
Argentol, 430 
Argonin, 430 
Aristol, 286, 340 
Aristolochin, 495 
Arnica, 266 
Arnicin, 266 
Aromatic acids, 304 

bitters, 494 

compounds, 289 

fluidextract of cascara sagrada, 522 

powder, 331, 337, 346 

spirit of ammonia, 272, 457 

sulphuric acid, 477 

syrup of rhubarb, 529 

tincture of rhubarb, 529 

vehicles, 330 

waters, 67 
Arsenic, 389 

iodidum, 389 

solutions, 68 

trioxide, 389 
Arseni iodidum, 389 

trioxidum, 389 
Asafetida, 358 
Asafcetida, 358 
Asaprol, 297 
Ascaris lumbricoides, 541 
Asparagin, 610 

hydrargyrate, 398 
Aspidium, 544 
Astringents, vegetable, 439 
Atropabelladonna, 200 

Mandragora, 202 
Atropina, 201 
Atropinae sulphas, 201 
Atropine, 200, 201 

compared with morphine, 205 

sulphate, 201 
Atrosin, 201 
Avoirdupois weights, 59 



Bacilli, 124 

Balsam of copaiba, 349 

of Peru, 355 

of tolu, 355 
Balsams, 316 
Balsamum Peruvianum, 355 

tolutanum, 355 

tranquillans, 129 

vitas Hoffmanni, 90 
Bandages, 136 

plaster-of-Paris, 138 
Barberry, 552 
Barker's pills, 123 
Barosma camphor, 347 
Basham's mixture, 68, 405, 572 
Basilicon, 132 
Bassorin, 601 

Bateman's pectoral drops, 102 
Battery-fluid, 70 
Bearberry, 347 
Beef and wine, 97 

4i 



Beef, wine and iron, 97 

iron and cinchona, 97 
Beer, 143 

heart, 149 
Belladona group, 199 

ointment, 201 

leaves, 200 

liniment, 201 

plaster, 200 

root, 201 
Belladonnas folia, 200 

radix, 201 
Belladonnine, 200 
Benzanilid, 306 
Benzoate of bismuth, 306 

of menthol, 306 
Benzoic acid, 305 
Benzoin, 304 
Benzoinated lard, 304 
Benzoinum, 304 
Benzonaphthol, 297, 306 
Benzosol, 300, 306 
Benzosulphinide, 585 
Benzosulphinidum, 585 
Benzoylecgonine, 217 
Benzoyl-eugenol, 345 
Berberine, 232, 494, 552 
Berberis, 552 
Bestucheff's tincture, 101 
Beta-naphthol, 296 
Beth root, 86 
Betol, 297 
Bhang, 191 
Bile, 607 

Biniodide of mercury, 397 
Birch, oil of, 314 

tar, 356 
Bismal, 435 
Bismuth, 433 

and ammonium citrate, 433 

chrysophanate, 435 

citrate, 433 

naphtholate, 435 

peroxide of, 278 

subcarbonate, 434 

subgallate, 434 

subnitrate, 434 

subsalicylate, 434 

tribromphenate, 435 
Bismuthi benzoas, 306 

citras, 433 

et ammonii citras, 433 

subcarbonas, 434 

subgallas, 434 

subnitras, 434 

subsalicylas, 434 
Bismutol, 435 
Bitter tincture, 10 1 

wine of iron, 97, 406 
Bitters, 493 
Black cohosh, 77 

draught, 95 

drop, 96 

haw, 86, 583 



642 



GENERAL INDEX. 



Black mustard, 321 

pepper, 343 

wash, 127, 398 
Blackberry, 449 

aromatic, 79 

compound, 85 

cordiaL 86 
Bland's pills, 120, 407 
Blistering cerate, 132 

collodion, 129, 319 

paper, 135 
Blisters, 318 
Bloodroot, 79, 558 
Blue mass, 118, 396 

ointment, 131, 397 

pill, 396 
Bolus, 124 
Bone-marrow, 607 
Boracic acid, 487 
Boral, 431 
Borates, 487 
Borax, 487 
Boric acid, 487 
Boulton's solution, 71 
Brandy, 142 
Brayero, 95, 545 
Breast tea, 96 
Bromalin, 568 
Bromelin, 500 
Bromides, 194 

comparative action of, 197 
Bromine, 593 

acne, 197 
Bromism, 196 
Bromoform, 140, 195 
Bromoformin, 168 
Bromoformum, 195 
Bromum, 593 
Broom, 225 

Brown mixture, 87, 556 
Brown-Sequard's antineuralgic pills, 122 
Brucine, 227 
Buchu, 347 
Buckthorn, 83 

berries, 79 
Burnt alum, 431 
Butyl, 139, 141 



Cachet, 113 
Cacodylates, 396 
Caffeina, 256 

citrata, 256 

effervescens, 256 
Caffeine, 256 

citrate, 256 
Calabar bean, 574 
Calabarine, 574 
Calamus, 337 
Calcareous waters, 474 
Call ii bromidum, 194 

< arbonas praecapitatus, 455 

hypophosphis, 387 

phosphas praxipitatus, 387 



Calcii sulphocarbolas, 302 
Calcined magnesia, 156, 523 
Calcis, 592 

chlorinatae, 284 
Calcium bromide, 191, 197 

hypophosphite, 387 

peroxide, 279 

preparations of, 455 

sulphocarbolate, 302 
Calendula, 494 
Calendulin, 494 
Calisaya and iron, 82 
Calomel, 397 

and jalap, 114 
Calumba, 493 
Calumbic acid, 494 
Calumbin, 494 
Calx, 592 

chlorinata, 284 
Cambogia, 535 
Camphor, 359 

ice, 132 

liniment, 359 

water, 359 
Camphora, 359 

monobromata, 359 
Camphorated naphthol, 297 

tincture of opium, 179, 359 
Camphoric acid, 359 
Canada liniment, 126 

snake root, 77 
Canadine, 232 
Cannabinol, 191 
Cannabis Indica, 191 
Cantharideal collodion 319 
Cantharides, 318 

cerate, 319 
Cantharidin, 319 
Cantharis, 318 

Capacities, metric table of, 62 
Capsaicin, 342 
Capsicum, 342 

plaster, 342 
Caraway, 334 
Carbasa, 137 
Carbolic acid, crude, 294 

soaps, 294 
Carbon tetrachloride, 163 
Cardamom, 337 
Cardamomum, 337 
Carminatives, 330 
Carniferrin, 408 
Carron oil, 125, 455 
Carum, 334 
Carvene, 334 
Carvone, 334 
Caryophyllus, 344 
Casca bark, 248 
Cascara sagrada, 85, 522 
Cassia fistula, 520 
Castor oil, 521 
Cataplasm, 136 

of kaolin, 602 
Cataplasma kaolini, 602 



GENERAL INDEX. 



643 



Catarrh snuff, 114 


Chloroform emulsion, 159 




Catechol, 295 


liniment, 159 




Cathartic acid, 532 


water, 67, 159 




Cathartics, 516 


Chloroformum, 159 




Catharticus compositas, 397 


Cholera mixture, 88 




Caustic potash, 591 


Chondrus, 602 




soda, 591 


Chromic acid, 590 




Caustics, 136, 589 


anhydride, 590 




Cayenne pepper, 342 


trioxide, 590 




Celery compound, 81 


trioxidum, 590 




Cephaeline, 511 


Chrysophan, 529, 532 




Cerata, 132 


Chrysophanic acid, 130 




Cerate of lead subacetate, 415 


Chrysotoxin, 249 




Cerates, 132 


Churchill's iodine caustic, 71 




Ceratum cantharidis, 319 


tincture of iodine, 102 




plumbi subacetatis, 415 


Cimicifuga, 77 




resinae compositum, 602 


Cinchona, 365 




Cerii oxalas, 437 


rubra, 366 




Cerium, 437 


Cinchonidinas salicylas, 367 




oxalate, 437 


sulphas, 366 




Cerous oxalate, 437 


Cinchonidine, 366 




Cevadilla, 263 


salicylate, 367 




Cevadine, 263 


sulphate, 366 




Ceylon cinnamon, 331 


Cinchonina iodosulphas, 367 




Chalk mixture, 87, 455 


Cinchoninae sulphas, 366 




Chalybeate pills, 120, 407 


Cinchonine, 366 




waters, 474 


iodosulphate, 286, 367 




Chamomile, 494 


sulphate, 366 




Channing's solution, 70 


Cinchonism, 371 




Chapman's dinner pill, 121 


Cineol, 335 




mixture, 89 


Cinnaldehyde, 332 




Charta sinapis, 322 


Cinnaldehydum, 332 




Chartae, 135 


Cinnamic acid, 332 




Chelene, 167 


aldehyde, 332 




Chemical food, 79 


Cinnamomum, 331 




incompatibility, 620 


saigonicum, 331 




waters, 67 


Cinnamon, 77, 331 




Chemistry, physical relation to pharma- 


water, 332 




cology and therapeutics, 32 


Cinnamyl cocaine, 211 




Chinoformin, 568 


Cinnamyl-eugenol, 345 




Chinoidine, 367 


Circulatory organs, drugs acting on, 


235 


Chinoidinum, 367 


Citarin, 568 




Chinolin, 367 


Citric acid, 483 




tartras, 367 


Citrine ointment, 131, 398 




tartrate, 367 


Citrophen, 381 




Chinotropin, 168 


Classification of medicines, 58 




Chirata, 494 


Clemens' solution, 71 




Chiratin, 494 


Climatotherapy, 26 




Chloral, 141 


Cloves, 344 




formamide, 175 


Coca, 8^, 210, 211 




Chloralamide, 141, 175 


Cocaina, 211 




Chloral -ammonium, 176 


Cocainae hydrochloridum, 211 




Chloralformamidum, 175 


Cocaine, 210, 211 




Chloralis, 175 


hydrochloride, 211 




Chloralose, 141, 176 


Cocainine, 217 




Chloralum hydratum, 170 


Cocamine, 211 




Chloral -urethane, 176 


Cocapyrine, 218 




Chloretone, 141, 176 


Codeina, 179 




Chlorhydrophosphate of lime, 77 


Codeinas phosphas, 179 




Chlorinated lime, 284 


Codeine, 179 




soda, solution of, 285 


phosphate, 179 




Chlorine, compound solution of, 284 


Cod -liver oil, 501 




Chloroform, 140, 159 


Coffee, 77 




anodyne, 88 


Cohosh, black, 77 





644 



GENERAL INDEX. 



Colchiceine, 578 

Colchicina, 578 

Colchicine, 578 

Colchicum, 578 

Colocynth, 535 

Colocynthidis, 535 

Colocynthin, 535 

Colocynthis, 535 

Cold cream, 130 

Cole's dinner pill, 121 

Collargolum, 430 

Collodia, 129 

Collodions, 129 

Collodium cantharidatum. 319 

stypticum, 439 
Colloidal silver, 430 
Colorless tincture of iodine, 102 
Columbo, 493 
Combination of drugs, 617 
Composition powder, 114 
Compound acetanilide powder, 376 
anise powder, 115 
cathartic pills, 397, 535 
chalk powder, 455 
effervescent powder, 452 
effervescing powder, 452, 540 
extract of colocynth, 527, 536 
fluidextract of sarsaparilla, 581 
infusion of rose, 95 

of senna, 333, 524, 532 
iron mixture, 334, 404 
jalap powder, 536 
laxative pills, 527 
liquorice powder, 333 
mixture of glycyrrhiza, 556 
pills of rhubarb, 527 
powder of catechu, 114 
of glycyrrhiza, 532, 556 . 
of jalap, 454 
of morphine, 179 
of rhubarb, 346, 456 
rhubarb pills, 529 

powder, 529 

rosin, cerate, 602 

solution of chlorine, 284 

of cresol, 294 

of iodine, 465 

spirit of ether, 154 

of juniper, ^t,, 334, 349 
syrup of hypophosphites, 388 
of sarsaparilla, 581 
of squill, 246, 509, 557 
tincture of benzoin, 305, 355. 527 
of cardamom, 331, 334, 337 
of cinchona, 366, 495 
of gambir, 331, 444 
of gentian, 493 

of lavender, 331 , 33S 
Compressed pills, 1 2 j. 
Condiment group, 342 
Confet tio rosae, 448 

senna-, 333, 520, 532 
Confe< tion, 1 1 2 

of rose. 448 



Confection of senna, 333, 520, 532 
Confectiones, 116 

Confections, 116 
Conii, 219 
Coniine, 219 
Conium, 219 
Conserve of rose, 117 
Conserves, 116 
Convallamarin, 245 
Convallaria, 245 
Convallarin, 245 
Convolvulin, 536 
Copaiba, 349 
Copaibic acid, 349 
Copper, 424 

sulphate, 424 
Cordials, 143 
Coriander, 332 

oil of, 333 
' Coriandrum, 332 
Corn collodion, 129 
Cornutine, 249 
Corrosive chloride of mercury, 397 

mercuric chloride, 397 

sublimate, 397 
Cosaprin, 381 
Cotarnine, 234 
Cotton, absorbent, 136 
Cotton-chloral, 175 
Cotton root bark, 253 
Cottons, medicated, 137 
Counterirritants, 318 
Coxe's hive syrup, 76 
Cramp bark, 584 
Cranesbill, 447 
Crayons, 136 
Cream of tartar, 454 
Creolin, 294 
Creosote, 299 

waters, 299 
Creosotum, 299 
Cresol, 293 

compound solution of, 294 
Cresols, 294 
Creta pracparata, 455 
Croton chloral, 141 

oil, 533 

collodion, 129 
Croton -chloral hydrate, 176 
Crude carbolic acid, 294 
Crurin, 435 
Crystallose, 585 
Cubeb, 351 
Cubeba, 351 
Cubebic acid, 351 
Cubcbin, 351 
Cudbear, 102 
Culver's root, 531 
Cupri sulphas, 424 
Curacas cordial, 80 
Curare, 222 
Curarine, 222 
Curassao, 80 
Curin, 222 



GENERAL INDEX. 



645 



Cusso, 95, 545 
Cutol, 431 
Cyanides, 486 
Cystamine, 568 
Cystogen, 568 



Dalby's carminative, 88 

Damiana, 86 

Dandelion, 526 

Daturine, 210 

Deadly nightshade, 200 

Decocta, 96 

Decoctions, 96 

Decoctum aloes compositum, 96 

Delirium tremens, 148, 149 

Demulcents, 594 

Denarcotized opium, 178 

Deodorant solution, 73 

Deodorized opium, 178 

Depressants, motor, 218 

Dermatol, 434 

Dermol, 435 

Desiccated suprarenal glands, 253 

thyroid glands, 605 
Dewees' carminative, 90 

tincture of guaiac, 102 
Diacetyl morphine, 189 
Diachylon, 134 

ointment, 415 

plaster, 415 
Diacodii, 79 
Diaphoretics, 569 
Dichloralantipyrine, 176 
Diet, 26 

Dietetic therapy, 26 
Diethyl-sulphon -diethyl -methane, 1 69 
Digestants, 498 
Digitalein, 236 
Digitalin, 236 
Digitalinum, 236 
Digitalis, 236 

group, 235 
Digitin, 236 
Digitonin, 236 
Digitophyllin, 236 
Digitoxin, 236 
Diluted acetic acid, 483 

alcohol, 142 

hydriodic acid, 466 

hydrobromic acid, 194, 197 

hydrochloric acid, 477 

hydrocyanic acid, 486 

hypophosphorous acid, 387 

muriatic acid, 477 

nitric acid, 478 

nitrohydrochloric acid, 477, 478 

phosphoric acid, 477 

solution of lead subacetate, 415 

sulphuric acid, 478 
Dimethyl ether, 163 
Dinner pills, 120, 121 
Dionine, 190 
Diosphenol, 347 



568 



Dioxybenzol-hexamethylenamine, 
Diphtheria antitoxin, 610 
Diseases, causes of, 21 

healing of, 21 
Dispensatories, 64 
Dithymol diiodide, 286 
Diuretics, 561 
Diuretin, 565 
Dobell's solution, 72 
Donovan's solution, 68, 390 
Dosage, 46 

influence of age on, 47 
of habit on, 48 
of idiosyncrasy on, 47 
of sex on, 48 
of temperament on, 47 
Young's rule for, 47 
Dose, 46 

Doses, intervals between, 48 
Dover's powder, 113, 178 
Draught, 95 
Dressings, antiseptic, 136 

medicated, 137 
Dried alum, 431 

ferrous sulphate, 407 
Drugs, administration of, 41 
by hypodermoclysis, 42 
by inunction, 41 
by mouth, 45 
by stomach, 44 
endermic method, 41 
enepidermic method, 41 
epidermic method, 41 
hypodermic method, 41 
internal, 45 
time for, 48 
application, local, to mucous mem- 
branes, 42 
to ear, 43 
to eye, 42 
to nose, 43 
to pharynx, 43 
to rectum, 43 
to respiratory tract, 43 
to urethra, 44 
classification of, 58 
conditions modifying action of, 46 
general action, 29 
inhalation of, 45 
intravenous injection of, 45 
official, 64 
officinal, 64 

physiological action and chemical com- 
position, 31 
untoward effects, 49 
Dry acid wines, 143 
Dulcin, 585 
Duotal, 300 
Duquesnel's oleate, 128 
Dysmenorrhcea mixture, 10 1 



Ear, application of drugs to, 43 
Ecbolics, 548 



646 



GENERAL INDEX. 



Effervescent Carlsbad salt, artificial, 116 

citrated caffeine, 256 

Kissingen salt, artificial, 116 

lithium citrate, 456 

magnesium sulphate, 539 

potassium citrate, 454 

salts, 115 

sodium phosphate, 453 

Vichy salt, artificial, 116 
Effervescing saline water, 72 
Egg-yolk, 94 
Elaterin, 534 
Elaterinum, 534 
Electrolytes, 33 
Electrotherapy, 26 
Electuar sennae, 117 
Electuaries, 116 
Elixir aurantiorum compositum, 97 

calisaya, 82 

corrigens, 81 

ferri, quininae et strychninae phos- 
phatum, 388 

of iron quinine and strychnine phos- 
phates, 388, 405 

of licorice, 81 

purgans, 85 
Elixiria, 80 
Elixirs, 80 

adjuvant, 80 

medicinal, 81 
Elm, 600 
Emesis, 505 
Emetics, 505 
Emetine, 511 
Emmenagogues, 548 
Emollient cataplasm, 96 
Emollients, 594 
Empirical therapeutics, 28 
Emplastra, 134 
Emplastrum adhaesivum, 602 

belladonnae, 200 

capsici, 342 

hydrargyri, 397 

opii, 178 

plumbi, 415 
Emulsa, 90 
Emulsin, 495 
Emulsion of asafetida, 359 

of cod-liver oil, 502 

with hypophosphites, 502 

of oil of turpentine, 324 
Emulsions, 90 
Emulsum amygdala?, 600 

asafoetida, 359 

chloroformi, 159 

olei morrhuae, 502 

cum hypophosphitibus, 502 
terebinthinae, 324 
Endermic method of administering drugs, 

41 
Enemata, 45 

nutrient, 44 
Enepidermic method of administering 

drugs, 41 



Enteroclysis, 26, 41 

Enterol, 293 

Enzymes, amylolytic, 500 

Epidermic methods of administering 

drugs, 41 
Epinephrine, 253 
Epsom salt, 539 
Ergot, 249 
Ergota, 249 
Ergotic acid, 249 
Ergotinic acid, 249 
Ergotism, acute, 251 

chronic, 251 
Ericolin, 348 
Erythrol tetranitrate, 270 
Erythrophleum, 248 
Erythroxyli, 97 
Erythroxylon coca, 210 
Escharotics, 136, 589 
Eseridine, 574 
Eserine, 574 

salicylate, 575 

sulphate, 575 
Essence of ginger, 73 

of peppermint, 339 

of spearmint, 340 

of wintergreen, 314 
Esters, 140 

Estimation of amounts of drugs, 623 
Ether, 140, 154 
Ethereal tinctures, 103 
Ethers, 139 

phenol, 298 
Ethyl alcohol, 139 

bromide, 162 

carbamate, 165 

chloride, 140, 162 

iodide, 162 
Ethylene, 140 

bichloride, 162 

bromide, 162 

iodide, 162 
Ethylidene chloride, 162 
Ethylidine, 140 
Eucaine, 217 
Eucalyptol, 335, 336 
Eucalyptus, 335 
Eudoxin, 286, 435 
Eugallol, 442 
Eugenol, 344, 345 
Eugenyl-acetamide, 345 
Euonymin, 530 
Euonymus, 530 
Euphthalmin, 202 
Euquinine, 368 
European hellebore, 263 
Europhen, 286 
Exalgine, 379 
Excipient, 118 
Excitants, motor, 226 
Expectorants, 553 

nauscant, 553 

sedative, 553 

stimulating, 553 



GENERAL INDEX. 



647 



Expressed oil of almond, 599 
Exsiccated sodium arsenate, 390 

phosphate, 453 
Extract of aloes, 527 

of belladonna leaves, 200 

of cascara sagrada, 522 

of colchicum corm, 579 

of colocynth, 536 

of digitalis, 236 

of ergot, 249 

of euonymus, 531 

of gentian, 493 

of glycyrrhiza, 556 

of haematoxylon, 446 

of hyoscyamus, 208 

of Indian Cannabis, 191 

of krameria, 445 

of leptandra, 531 

of malt, 501 

of mix vomica, 227 

of opium, 178 

of physostigma, 575 

of quassia, 493 

of rhubarb, 529 

of scopolae, 208 

of sumbul, 585 

of taraxacum, 526 
Extracta, 108 

Extractive preparations, 66, 94 
Extracts, 108 
Extractum aloes, 527 

belladonnae foliorum, 200 

cannabis indicae, 191 

colchici cormi, 579 

colocynthidis, 536 

compositum, 527, 536 

digitalis, 236 

ergotae, 249 

euonymi, 531 

gentianae, 493 

glycyrrhizae, 556 
purum, 556 

haematoxyli, 446 

hyoscyami, 208 

krameriae, 445 

leptandrae, 531 

malti, 501 

nucis vomicae, 227 

opii, 178 

physostigmatis, 575 

quassiae, 493 

rhamni Purshianae, 522 

rhei, 529 

scopolae, 208 

sumbul, 585 

taraxaci, 526 
Eye, application of drugs to, 42 



False hellebore, 247 
Fats and oils, 501 
Fatty compounds, 289 
Fehling's solution, 70 
Fel bovis, 528 



Fel purifkatum, 528 
Fennel, 333 

water, 333^ 
Fenner's guaiac mixture, 101 
Fer'alboid, 408 
Fercremol, 408 
Ferralbumose, 408 
Ferrated elixir of calisaya, 82 

extract of apples, 101 
Ferratin, 408 
Ferri, 404 

carbonas saccharatus, 404 

chloridum, 404 

citras, 405 

et ammonii, citras, 405 
sulphas, 406 
tartras, 406 

et potassii tartras, 406 

et quininae citras, 405 
compositae, 124 
solubilis, 405 

et strychnin ae citras, 406 

hydroxidum, 406 
cum magnesia, 406 

hypophosphis, 407 

oxidum hydratum, 406 

phosphas solubilis, 406 

pyrophosphas solubilis, 407 

sulphas, 407 
exsiccatus, 401 
granulatus, 407 
Ferric ammonium sulphate, 406 

chloride, 404 

citrate, 405 

hydroxide, 406 

with magnesia, 406 

hypophosphite, 407 
Ferripyrin, 375, 408 
Ferrosol, 408 
Ferrostyptin, 408 
Ferrous chloride, 70, 78 

sulphate, 407 
Ferruginous pills, 120, 407 
Ferrum, 404 

casein atum, 408 

reductum, 404 
Fersan, 408 
Filicic acid, 545 
Fluidextract of aconite, 260 

of belladonna root 201 

of berberis, 552 

of black haw, 583 

of buchu, 347 

of calamus, 338 

of calumba, 494 

of capsicum, 342 

of chirata, 494 

of cinchona, 366 

of coca, 211 

of colchicum seed, 579 

of conium, 219 

of convallaria, 245 

of cramp bark, 584 

of cubeb, 352 



6 4 8 



GENERAL INDEX. 



Fluidextract of digitalis, 236 

of ergot, 249 

of eucalyptus, 335 

of euonynius, 531 

of gelsemium, 223 

of gentian, 493 

of geranium, 447 

of ginger, 346 

of glycyrrhiza, 556 

of grindelia, 353 

of hamamelis leaves, 446 

of hydrastis, 233 

of hyoscyamus, 208 

of Indian cannabis, 191 

of ipecacuanha, 511 

of krameria, 445 

of leptandra, 531 

of lobelia, 515 

of lupulin, 190 

of mezereum, 588 

of nux vomica, 227 

of phytolacca, 265 

of pilocarpus, 569 

of podophyllum, 538 

of pomegranate, 546 

of quassia, 493 

of quercus, 443 

of rhubarb, 529 

of rhus glabra, 448 

of rose, 448 

of rubus, 449 

of sanguinaria, 558 

of sarsaparilla, 581 

of savine, 549 

of scopola, 209 

of senega, 557 

of senna, 532 

of serpentana, 495 

of spigelia, 544 

of squill, 246 

of stillingia, 582 

of sumbul, 585 

of taraxacum, 526 

of uva ursi, 348 

of valerian, 360 

of veratrum, 263 

of wild cherry, 495 

of xanthoxylum, 589 
Fluidextracta, 103 
Fluid extracts, 103 
Fluidextractum aconite, 260 

aromaticum, 337 

belladonnse radicis, 201 

berberidis, 552 

buchu, 347 

calami, 338 

calumbae, 494 

cannabis indicac, 191 

capsici, 342 

chiratae, 494 

cinchona;, 366 

(oc-c, 211 

c olc hie i scminis, 579 

conii, 219 



Fluidextractum convallariae, 245 

cubebae, 352 

digitalis, 236 

ergotae, 249 

eucalypti, 335 

euonymi, 531 

gelsemii, 223 

gentianae, 493 

geranii, 447 

glycyrrhizae, 556 

granati, 546 

grindeliae, 353 

hamamelidis foliorum, 446 

hydrastis, 233 

hyoscyami, 208 

ipecacuanhas, 511 

krameriae, 445 

leptandras, 531 

lobeliae, 515 

lupulini, 190 

mezerei, 588 

nucis vomicae, 227 

Phytolacca, 265 

pilocarpi, 569 

podophylli, 538 

pruni Virginianae, 495 

quassiae, 493 

quercus, 443 

rhamni Purshianae aromaticum, 522 

rhei, 529 

rhois glabra, 448 

rosae, 448 

rubi, 449 

sabinae, 549 

sanguinariae, 558 

sarsaparillae, 581 
compositum, 581 

scillae, 246 

scopolae, 209 

senegae, 557 

sennae, 532 

serpentariae, 495 

spigeliae, 544 

stillingiae, 582 

sumbul, 585 

taraxaci, 526 

uvae ursi, 348 

Valerianae, 360 

veratri, 263 

viburni opuli, 584 
prunifolii, 584 

xanthoxyli, 589 

zingiberis, 346 
Fluorescein, 295 
Fluorine, 283 
Fceniculum, 333 
Fomentations, 136 
Formaldehyde, solution of, 314 
Formalin, 314 
Formamidati, 175 
Formic ether, 163 
Formin, 568 
Formol, 314 
Formulary, National, 64 



GENERAL INDEX. 



649 



Fowler's solution, 68, 389 
Fox-glove, 236 
Francis's triplex pills, 124 
French mixture, 71 
Friable pills, 124 
Fusel oil, 139 



Gadberry's mixture, 90 
Galla, 442 
Gallal, 431 
Gallanol, 442 
Gallic acid, 441 
Gallicine, 442 
Gambir, 443 
Gamboge, 535 
Gastric sedatives, 506 
Gauzes, medicated, 137 
Gelatin, 603 
Gelatinum, 603 

glycerinatum, 596 
Gelsemii, 223 
Gelsemina, 223 
Gelsemine, 223 
Gelseminine, 223 
Gelsemium, 223, 227 
Gentian, 493 
Gentiana, 493 
Gentiopicrin, 493 
Gentisic acid, 493 
Geranium, 447 
German tinctures, 98 
Germicides, oxidizing, 277 
Gin, 143 
Ginger, 346 

Glacial acetic acid, 483, 592 
Glandulae suprarenales siccae, 253 

thyroideae siccae, 605 
Glandularum suprarenalium siccarum, 

253 
Glauber's salt, 540 
Globules, 124 
Glucosimide, 585 
Glutol, 315 
Glycerin, 596 

and oint., 130 
Glycerinated gelatin, 596 
Glycerinum, 596 
Glycerita, 86 
Glycerite of boroglycerin, 487 

of glyceryl borate, 487 

of hydrastis, 233 

of phenol, 289 

of phosphates of iron, quinine and 
strychnine, 388 

of starch, 596 

of tannic acid, 439 
Glycerites, 86 
Glyceritum acidi tannici, 439, 596 

amyli, 596 

boroglycerini, 487, 596 

ferri, quininse et strychnine phospha- 
tum, 388 

hydrastis, 233, 596 



Glycerum phenolis, 289, 596 

Glycerole of pepsin, 86 

Glyceroles, 86 

Glycoside, 495 

Glycyrrhiza, 555 

Glycyrrhizin, 556 

Glycyrrhizinum ammoniatum, 556 

Godfrey's cordial, 90 

Golden seal, 232 

Gossypii cortex, 253 

Goulard's cerate, 132, 415 

extract, 415 
Granatum, 546 

Granulated ferrous sulphate, 407 
Granules, 124 
Green iodide of mercury, 397 

tinctures, 98 
Gregory's powder, 529 
Griffith's mixture, 87, 404 
Grindelia, 353 

Gross' antineuralgic pills, 122 
Guaiac, 582 

mixture, 89 
Guaiacol, 300 

benzoate, 300 

carbonate, 300 

salicylate, 301 
Guaiacolis benzoas, 300 

carbonas,' 300 

salicylas, 301 
Guaiacol -salol, 301 
Guaiacum, 582 
Gum arabic, 600 
Gunjah, 191 



H^malbumin, 408 
Haematoxylon, 445 
Haemoferrum, 408 
Ffaemogallol, 407 
Haemoglobin, 408 
Haemol, 407 
Haller's acid elixir, 90 
Hall's dinner pill, 121 

solution of strychnine, 72 
Halogen derivatives of alcohol, 169 
Halogens, 283 
Hamamelidis cortex, 446 

folia, 446 
Hamamelis, 446 

leaves, 446 

water, 446 
Hashish, 191 
Haustus, 95 
Heavy magnesia, 456 

metals, 414 
Hebra's itch ointment, 130, 132 
Hedeoma, 552 
Hedonal, 140, 165 
Helcosol, 435 
Heliotherapy, 26 
Heliotropin, 343 
Hellebore, American, 263 

European, 263 



6^o 



GEXERAL IXDEX 



Hellebore, false, 247 
Helmitol, 568 
Hemlock, spotted, 219 
Henbane, 207 
Heroin, 189 
Hetoform, 435 
Hetralin, 568 
Hexamethylenamina, 568 
Hexamethylenamine, 5 68 

salicylate, 568 
Hexamethylenamine-ethylbromide, 568 
Hexamethylenamine-tannin, 568 
Hiera picra, 114 
Hive syrup, 509 
Hoffmann's anodyne, 74, 1.54 
Holocaine, 217 

Homatropinae hydrobromidum. 201 
Homatropine hydrobromide, 2c 1 
Hope's mixture, 88 
Hops, 190 
Hot drops, 101 
Humulus, 190 
Huxham's tincture, 99 
Hydra gogue purgatives, 533 
Hydrargyri chloridum corrosivum, 397 
mite, 397 

iodidum flavum, 397 
rubrum, 397 
viride, 397 

oxidum flavum, 397 
rubrum, 398 
Hydrargyrum, 396 

ammoniatum, 396 

cum creta, 396, 455 
Hydrastina, 233 

Hvdrastinae hvdrochloridum, 233 
Hydrastine, 232, 233 
Hydrastinine hydrochloride, 233 
Hydrastis, 232 
Hydrated chloral, 170 

oxide of iron, 406 
Hydrazine derivatives, 375 
Hydrochinone, 295 
Hydrochloric acid, 477 
Hydrocyanic acid, 4S6, 495 
Hydrogen dioxide, solution of, 277 

peroxide, 67 
Hydronaphthol, 297 
Hydroquinol, 295 
Hydroquinone, 295 
Hydrotherapy, 26 

Hydrous wool-fat and petrolatum, 131 
Hygrine, 211 

Hyoscinae hydrobromidum, 208 
Hyoscine, 207 

hydrobromide, 20S 
Hyoscyaminae hydrobromidum, 208 

sulphas, 208 
Hyoscyamine, 200, 207 

hydrobromide, 208 

sulphate, 208 
• amus, 207 
Hypnal, 176, 375 
Hypnonc, 176, 177 



Hypnotics, 164 

Hypodermic method of administering 

drugs, 41 
Hypodermoclysis, 26, 42 
Hypophosphite of iron, 7S 

of lime, 77 
and soda, 77 
Hypophosphorous acid, 387 



Iatrol, 286 
Ichthyargon, 430 
Ichthyol, 303 
Ichthyolum, 303 
Imidiol, 286 
Incompatibility, 620 

chemical, 620 

pharmaceutical, 621 
Indian cannabis, 191 

hemp, 191 

senna, 532 

tobacco, 514 
Inee, 243 
Inege, 243 
Infusa, 95 
Infused oils, 128 
Infusion of digitalis, 236 

of pectoral species, 96 

of wild cherry, 495 
Infusions, 95 
Infusum digitalis, 236 

pectorale, 96 

pruni Virginianse, 495 

sennas compositum, 7,7,7,, 524, 532 
Inhalation of drugs, 45 
Inscription, 616 

Intravenous injection of drugs, 45 
Inulin, 526 
Inunction. 41 
Iodic acid, 467 
Iodide of calcium, 77 

of iron and manganese, 78 
Iodides, 465 
Iodine, 465 

caustic, 71 

ointment, 465 

tribromide, 467 

trichloride, 467 
Iodized collodion, 129 
Iodo-albumin, 467 
Iodoanisol, 286 
Iodocasein, 286 
Iodocrol, 286 
Iodoform, 140, 2S5 

and naphthalin, 114 

collodion, 129 
Iodoformal, 2S6 
Iodoformogen, 286 
Iodoformum, 285 
Iodogallicin, 286, 435 
Iodol, 285 
Iodolum, 285 
Iodophenine, 467 
Iodopin, 467 



GENERAL INDEX. 



651 



Iodopyrine, 467 

Iodoterpin, 286 

Iodotheine, 467 

Iodotheobromin, 467 

Iodothymoform, 286, 340 

Iodothyrin, 467, 605 

Iodum, 465 

Ions, 31, ^3 

Ipecac, 511 

Ipecacuanha, 511 

Irish moss, 77, 602 

Iron, 404 

and ammonium citrate, 405 

tartrate, 406 
and potassium tartrate, 406 
and quinine citrate, 405 
and strychnine citrate, 404 
by hydrogen, 404 
quinine chloride, 408 
solutions, 68 

Irritants, 318 

Isococamine, 211 

Isopelletierine, 546 

Isopral, 176 

Isopunicine, 546 

Itrol, 430 



Jaborandi, 84, 569 
Jaborine, 569 

Jackson's pectoral syrup, 79 
Jalap, 536 
Jalapa, 536 
Jalapin, 536, 537 
Jamestown weed, 210 
Janeway's pills, 121 
Japaconitine, 260 
Javelle water, 71 
Jimson weed, 210 
Juniper, 348 

berries, 348 
Juniperus, 348 



Kairine, 367 

Kaolin, 602 

Kaolinum, 602 

Kations, 33 

Kelene, 162 

Kidneys, drugs acting on, 561 

Kinesotherapy 26 

Kino, 444 

Kombe, 243 

Konseals, 113 

Kosotoxin, 546 

Kousso, 545 

Krameria, 444 



Labarraque's solution, 69, 285 
Lac sulphur, 524 
Lactanines, 435 
Lactic acid, 482 
Lactophenin, 381 



Lactophosphate of calcium, 77 

of iron, 78 

of lime with iron, 77 
Lactucarium, 190 

Lady Webster's dinner pills, 121, 527 
Lafayette mixture, 89 
Lamellae, 124 
Lamott's drops, 10 1 
Lard, benzoinated, 304 
Largin, 430 
Lasophan. 286 
Laudanum, 179 
Laughing gas, 163 
Laurocerasin, 495 
Lavender flowers, oil of, 338 
Laxantes, 96 
Laxative elixir, 85 
Laxatives, 520 
Lead, 414 

acetate, 414 

iodide, 415, 467 

nitrate, 415 

oxide, 415 

plaster, 415 

water, 69, 415 
Lead-and-opium, wash, 127 
Lengths, metric table of, 62 
Lenigallol, 442 
Leptandra, 531 
Leptandrin, 531 
Levant wormseed, 542 
Light magnesia, 456, 523 

red wines, 143 
Lily of the valley, 245 
Lime, 592 

chlorinated, 284 

juice and pepsin, 86 

liniment, 455 

water, 69, 455 
Linen, 136 
Linimenta, 125 
Liniments, 125 
Linimentum album, 126 

ammoniae, 272 

belladonnae, 201 

calcis, 455 

camphorae, 359 

chloroformi, 159 

crotonis, 126 

saponis, 359 

terebinthinae, 324 
Linseed oil, 599 
Lint, 137 

Liquefied phenol, 290 
Liquid measures, 59 

mixtures, internal, 66, 87 

rennet, 72 
Liquor acidi arsenosi, 389 

ammonii acetatis, 572 

antisepticus, 487 

arseni et hydrargyri iodidi, 390, 397 

arsenii bromidi, 71 

calcis, 455 

chlori compositus, 284 



652 



GENERAL INDEX. 



Liquor cresolis compositus, 294 

ferri chloridi, 405 

et ammonii acetatis, 405, 572 
subsulphatis, 407 
tersulphatis, 407 

formaldehydi, 314 

hydrargyri nitratis, 398 

iodi causticus, 102 
compositus, 465 

magnesii citratis, 457, 539 

plumbi subacetatis, 415 
dilutus, 415 

potassii arsenitis, 389 
citratis, 455 
hydroxidi, 453 

sodae chlorinatae, 285 

sodii arsenatis, 390 
hydroxidi, 451 
phosphatis compositus, 540 

zinci chloridi, 593 
Liquores, 67 
Liquorice, 78 

root, 555 
Liquors, unofficial, 69 
Litharge, 415 
Lithii benzoas, 305 

bromidum, 194 

carbonas, 456 

citras, 456 

effervescens, 456 

salicylas, 308 
Lithium benzoate, 305 

bromide, 194, 197 

carbonate, 456 

citrate, 456 

preparations of, 456 

salicylate, 308 
Lithontriptics, 561 
Lobelacrin, 514 
Lobelia, 514 
Lobelic acid, 514 
Lobeline, 514 
Local anesthetics, 154 

antiemetics, 506 
Logwood, 445 

Loomis' diarrhea mixture, 89 
Loretin, 286 
Lotio flava, 398 

nigra, 398 
Lotiones, 127 
Lozenges, 1 1 7 
Lugol's solution, 69, -465 
Lunar caustic, 427 
Lupulin, 190 
Lupulinum, 190 
Lycetoi, 567 
Lycopodium, 603 



Lysidi 
Lysol, 294 



Mack, 344 
M;i( is, 344 



'7 



Magendie's solution of morphine, 71 



Magnesia, 456 

Magnesii carbonas, 457, 523 

oxidum, 456, 523 
ponderosum, 456 

sulphas, 457, 539 
effervescens, 539 

sulphocarbolas, 302 
Magnesium carbonate, 457, 523 

oxidum, 523 

preparations of, 456 

sulphate, 457, 539 

sulphocarbolate, 302 
Malakin, 381 
Malarine, 177 
Malate of iron, 101 
Male fern, 544 
Malt, 500 
Maltum, 500 
Manganese, 412 

hypophosphite, 413 

sulphate, 413 
Mangani dioxidum precipitatum, 412 

hypophosphis, 413 

sulphas, 413 
Manna, 523 

Mannitol hexanitrite, 270 
Marigold, 494 
Marshmallow, 601 
Mass of ferrous carbonate, 404 

of mercury, 396 
Massa ferri carbonatis, 404 

hydrargyri, 396, 596 
Massae, 118 
Masses, 112, 118 
Materia medica, 23 
Matris camphoratum, 135 
May apple, 537 
Mayet's paste, 593 
Meadow saffron, 578 
Measures and weights, 59 
Medicated cottons, 137 

dressings, 137 

gauzes, 137 

waters, 67 
Medicinal elixirs, 81 
Medicines, classification of, 58 
Mentha piperita, 338 

viridis, 340 
Menthol, 339 

benzoas, 306 
Mercurial ointment, 130, 397 

plaster, 397 
Mercury, 396 

with chalk, 390, 455 
Metallic compounds, solutions of, 69 
Metallorum amara, 123 
Metals and their salts, 280 

heavy, 414 
Mcthanal, 314 
Methyl alchol, 139 

chloride, 162 

salicylate, 314 
Mcthvlacetanilide, 379 
Methylal, 140, 163, 104 



GENERAL INDEX 



653 



Methylaldehyde, 314 
Methylarbutin, 348 
Methylene, 163 

bichloride, 163 

blue, 586 

chloride, 140 
Methylic ether, 163 
Methylis salicylas, 314 
Methylpelletierine, 546 
Methylpunicine, 546 
Methylthioninae hydrochoridum, 586 
Methylthionine hydrochloride, 586 
Metric system, 60 

table of weights, 62 
of capacities, 62 
of lengths, 62 
Mezerein, 588 
Mezereum, 588 
Mild chloride of mercury, 397 

mercurous chloride, 397 
Milk of sulphur, 524 
Mineral acids, 476 

waters, 472 
Mistura antidysenterica, 88 

cretae, 455 

ferri composita, 334, -40-1 

glycyrrhizse composita, 556 

gummosa, 88 

opii alkalina, 90 

rhei et sodas, 452, 529 

solvens simplex, 88 
stibiata, 88 
Misturae, 87 
Mitigated caustic, 426 

silver nitrate, 426 
Mixture of chloral and bromide, 88 

of rhubarb and soda, 452, 529 
Mixtures, 87 

liquid, internal, 66 
of solids, external, 66 
internal, 66 
Molded silver nitrate, 427 
Monacetyl morphine hydrochloride, 190 
Monobromated camphor, 359 
Monochlorantipyrine, 176 
Monohydrated sodium carbonate, 452 
Monsel's solution, 68, 407 
Morphina, 179 
Morphinas acetas, 179 

hydrochloridum, 179 

sulphas, 179 
Morphine, 179 

acetate, 179 

compounds, allied, 189 

hydrochlorate, 179 

sulphate, 179 
Morrhuol, 501 
Mother's salve, 131 
Motor depressants, 218 

excitants, 226 
Mouth, administration of drugs by, 45 
Moxa, 136 
Mucilage of acacia, 600 

of elm, 600 



Mucilage of sassafras pith, 601 

of tragacanth, 601 
Mucilages, 87 
Mucilagines, 87 
Mucilago acacias, 600 

sassafras medullas, 601 

tragacanthas, 596, 601 

ulmi, 600 
Mucous membrane, respirator} 7 , drugs 
acting on, 553 

membranes, local applications of drugs 
to, 42 
Muriatic acid, 477 
Mustard, black, 321 

leaves, 323 

paper, 322 

volatile oil of, 322 

whey, 323 

white, 321 
Myristica, 344 
Myrosin, 322 
Myrrh, 334 



Naphthalene, 296 

Naphthalenum, 296 

Naphthol, comphorated, 297 

Naphtosalol, 297 

National formulary, 64 

Nervous system, drugs acting on, 139 

Neuralgia pills, 122 

Neutral mixture, 68 

Nitrates, 463 

Nitre, 463 

Nitric acid, 478 

Nitroglycerin pills, 123 

spirit of, 270 
Nitrohydrochloric acid, 477, 478 
Nitrous oxide, 163 
Nose, application of drugs to, 43 
Nosophen, 286 
Nucis vomicas, 227 
Nuclein, 606 
Nut gall, 442, 
Nutmeg, 344 
Nutrient enemata, 44 
Nux vomica, 227 



Oil of allspice, 346 
of American wormseed, 542 
of anise, 330 
of birch, 314 
of cade, 357 
of cajuput, 336 
of caraway, 334 
of cinnamon, 331 
of cloves, 344 
of copaiba, 349 
of coriander, 333 
of cubeb, 352 
of eucalyptus, 335 
of fennel, 333 
of flaxseed, 599 



654 



GENERAL INDEX. 



Oil of hedeoma, 552 
of juniper, 348 
of lavender flowers, 338 
of nutmeg, 344 
of pennyroyal, 552 
of rue, 550 
of sandalwood, 351 
of santal, 351 
of savin e, 549 
of spearmint, 340 
of tar, 356 
of turpentine, 324 
of winter green, 313 
Oils and fats, 501 

volatile, 316 
Ointment, 603 

of ammoniated mercury, 396 
of boric acid, 487 
of iodoform, 285 
of mercuric nitrate, 398 
of nutgall, 442 
of phenol, 289 
of potassium iodide, 466 
of red mercuric oxide, 398 
of tannic acid, 439 
of yellow mercuric oxide, 398 
of zinc oxide, 421 
Ointments, 129 
Olea infusa, 128 
Oleata, 127 
Oleate of aconite, 260 
of atropine, 201 
of cocaine, 211 
of sodium, 72 
of veratrine, 263 
Oleates, 127 
Oleatum aconitinae, 260 
atropine, 201 
cocainae, 211 
veratrinae, 263 
Oleoresin of aspidium, 545 
of capsicum, 342 
of cubeb, 352 
of ginger, 346 
of lupulin, 190 
of pepper, 343 
Oleoresina aspidii, 545 
capsici, 342 
cubebae, 352 
lupulini, 190 
piperis, 343 
zingiberis, 346 
Oleoresin®, 109 
Oleoresins, 109, 316 
Oleum amygdalae expressum, 599 
anisi, 330 
betulae, 314 
cadinum, 357 
cajuputi, 336 
can, 334 
caryophylli, 344 
chenopodii, 542 
cinnamomi, 331 
copaiba?, 349 



Oleum coriandri, 333 

cubebae, 352 

eucalypti, 335 

fceniculi, 2>2>3 

gaultheriae, 313 

hedeomae, 552 

juniperi, 348 

lavandulae florum, 338 

lini, 599 

menthae piperitae, 338 
viridis, 340 

morrhuae, 501 

myristicae, 344 

olivae, 598 

picis liquidae, 356 

pimenta, 346 

ricini, 521 

rusci, 356 

rutae, 550 

sabinae, 549 

santali, 351 

sinapis volatile, 322 

terebinthinae, 324 
rectificatum, 324 

tiglii, 533 
Olive oil, 598 
Ophelic acid, 494 
Opii deodorati, 178 

pulvis, 178 
Opium, 177 

compared with its alkaloids, 189 

deodoratum, 178 

granulatum, 178 

plaster, 178 
Opodeldoc, 126 
Opothyroidine, 605 
Orbiculae, 124 
Ordeal bark, 248 
Organic acids, 482 

peroxides, 278 
Organotherapy, 604 
Orphal, 435 
Orthin, 375 

Orthodioxybenzene, 295 
Orthoform, 218 
Ouabain, 243 
Oxgall, 528 

Oxidizing germicides, 277 
Oxymel of squill, 80 
Oxymethylene, 314 
Oxysulphate of iron, 70 
Oxytocics, 548 
Oxyuris vermicularis, 541 



Pancreas extracts, 607 
Pancreatic solution, 71 
Pancreatin, 499 
Pancreatinum, 499 
Pankreon, 499 
Papain, 500 
Papaveris, 79 
Papayotin, 500 
Papers, 135 



GENERAL INDEX. 



655 



Papoid, 500 
Paradioxybenzene, 295 
Paraffin, 603 

and white petrolatum, 130 
Paraffinum, 603 
Paraform, 314 
Paraldehyde, 140, 166 
Paraldehydum, 166 
Parathyroid gland, 606 
Paregoric, 99, 179 
Parillin, 581 

Parrish's camphor mixture, 88 
Parsley, 551 
Parvules, 124 

Pearson's solution, 72, 390 
Pectoral infusion, 96 
Pectorales, 96 
Pectoralis, 79 
Pelletierinae tannas, 546 
Pelletierine, 546 

tannate, 546 
Pencils, 136 
Pennyroyal, 552 
Pental, 163 
Pepo, 547 
Pepper, 343 

black, 343 

cayenne, 342 
Peppermint, 338 

water, 339 
Pepsin, 98, 498 
Pepsinum, 498 
Peptonizing powder, 114 
Peronine, 190 
Peroxide of bismuth, 278 

organic, 278 
Persodines, 279 
Petrolatum album, 598 

white, 598 
Petroselinum, 551 
Pharmaceutical incompatibility, 621 

preparations, 64 
Pharmacodynamics, 23 
Pharmacognosy, 23 
Pharmacology, 23 
Pharmacopoeia, 64 
Pharmacotherapy, 28 
Pharmacy, 23 

Pharynx, application of drugs to, 43 
Phenacetin, 380 
Phenate of cocaine, 216 
Phenocoll, 380 

hydrochloride, 380 
Phenol, 289 

ethers, 298 

liquef actum, 290 
Phenol sodique, 72 
Phenyl salicylate, 312 
Phenylacetamide, 376 
Phenylhydrazine, 375 
Phenylis salicylas, 312 
Phesin, 381 
Phloroglucin, 296 
Phosphatic emulsion, 94 



Phosphoric acid, 477 
Phosphorus, 382 

Physical chemistry, relation to pharma- 
cology and therapeutics, 32 
Physicomechanical therapy, 26 
Physiological therapeutics, 29 
Physosterin, 574 
Physostigma, 227, 574 
Physostigminae salicylas, 575 

sulphas, 575 
Physostigmine, 574, 575 

salicylate, 575 

sulphate, 575 
Phytolacca, 265 
Picis betulae, 356 

liquidae, 356 
Picrasmin, 493 
Picropodophyllin, 538 
Pills, 112, 118 

of aloes, 527 

and iron, 407, 527 
and mastich, 527 
and myrrh, 334, 527 

of asafetida, 359 

of ferrous carbonate, 407 
iodide, 404 

of opium, 178 

of phosphorus, 383 

of podophyllum, belladonna, and cap- 
sicum, 538 
Pilocarpidine, 569 
Pilocarpinae hydrochloridum, 569 

nitras, 569 
Pilocarpine, 569 

hydrochloride, 569 

nitrate, 569 
Pilocarpus, 569 
Pilula hydrargyri, 396 
Pilulae, 118 

aloes, 527 

et ferri, 407, 527 
et mastiches, 527 
et myrrhae, 334, 527 

asafcetidae, 359 

catharticas compositae, 397, 535, 536 
vegetabiles, 531, 536 

cochia, 123 

ferri carbonatis, 407 
iodidi, 404 

laxativae compositae, 527 

opii, 178 

phosphori, 383, 596 

podophylli, belladonnae et capsici, 538 

rhei compositae, 527, 529 
Pimenta, 346 
Pimpinella, 102 
Pinkroot, 544 
Piper, 343 
Piperazin, 567 
Piperazinum, 567 
Piperin, 343 
Piperinum, 343 
Piperonal, 343 
Pituitary body 606 



6 5 6 



GENERAL INDEX. 



Pix betulae, 356 
liquida, 356 
Plaster-mull, 136 
Plaster-of-Paris bandages, 138 
Plasters, 134 
Plumbi acetas, 414 

iodidum, 415, 467 
nitras, 415 
oxidum, 415 
Plumbum, 414 
Podophyllin, 538 
Podophyllotoxin, 538 
Podophyllum, 537 
Poison ivy, 329 
Poke-root, 265 
Polypharmacy, 617 
Pomegranate, 546 
Poppy, 79, 102 
Port wine, 143 
Porter, 143 
Potassa, 591 
Potassii acetas, 453 

bicarbonas, 454 

bitartras, 454 

bromidum, 194 

carbonas, 454 

chloras, 490 

citras, 454 

effervescens, 454 

cyanidum, 486 

dichromas, 489 

et sodii tartras, 539 

hydroxidum, 591 

hypophosphis, 387 

iodidum, 466 

nitras, 463 

permanganas, 279 

sulphas, 539 

sulphocarbolas, 302 
Potassio-ferric tartrate, 406 
Potassium acetate, 453 

and sodium tartrate, 539 

bicarbonate, 454 

bitartrate, 453 

bromide, 19-4, 197 

carbonate, 454 

chlorate, 490 

citrate, 454 

compounds, 453 

cyanidum, 486 

dichromate, 489 

hydroxide, 591 

hypophosphlte, 387 

iodide, 466 

nitrate, 463 

permanganate, 279 

sulphate, 539 

sulphocarbolate, 302 
Potio Riveri, 72 
Poultice, 136 

Powder of ipecac and opium, 178, 511 
Powdered opium, 178 
Powders, in, 112 
Precipitated calcium carbonate, 455 



Precipitated calcium phosphate, 387 

manganese dioxide, 412 

sulphur, 524 

zinc carbonate, 420 
Preparations, extractive, 94 

for external use, 125 
Prepared chalk, 455 
Prescriptions, 616 

language and grammatical construction 
of, 625 
Prescription-writing, 616 
Prickly ash, 588 
Proof spirit, 143 
Propyl, 139 
Protargol, 430 
Protectives, 595 
Protiodide of iron, 78 

of mercury, 397 
Protocurarine, 222 
Prunus Virginiana, 495 
Pseucaconitine, 260 
Pseudojervine, 263 
Pseudopelletierine, 546 
Pseudopunicine, 546 
Pulsatilla, 266 
Pulveres, 112 
Pulvis acetanilidi compositus, 376 

aromaticus, 331, 337, 346 

cretae compositus, 455, 600 

digestivus, 114 

effervescens compositus, 452, 540 

glycyrrhizse compositus, ^^t,, 532, 556 

gummosus, 113 

ipecacuanhas et opii, 178, 511 

jalapae compositus, 454, 53(5 

morphinse compositus, 179 

rhei compositus, 346, 456, 529 
Pumpkin seed, 547 
Punicine, 546 
Punicinum tannicum, 546 
Pure extract of glycyrrhiza, 556 
Purgatives, 516 
Purging cassia, 520 
Purified aloes, 527 

oxgall, 528 

talc, 602 
Pustulants, 318 
Pustules, 318 
Pyramidon, 375 
Pyrocatechin, 295 
Pyrodine, 375 
Pyrogallic acid, 442 
Pyrogallol, 296, 442 
Pyrrhol group, 373 



Quassia, 493 
Quassin, 493 

Queen's root, 582 
Quercus, 443 
Qucvenne's iron, 404 
Quicksilver, 396 
Quinetum, 367 
Quinia, 366 



GENERAL INDEX. 



657 



Quinidine, 366 
Quininae bisulphas, 366 

hydrobromidum, 366 

hydrochloras carbamidata, 367 

hydrochloridum, 367 

salicylas, 367 

sulphas, 367 
Quinine, 366 

bisulphate, 366 

hydrobromide, 366 

hydrochloride, 367 

salicylate, 367 

sulphate, 367 
Quinolin, 367 

group, 365 
Quinoline, 367 



Rational therapeutics, 29 
Rectified oil of turpentine, 324 

spirit, 143 
Rectum, application of drugs to, 43 
Red cinchona, 366 

iodide of mercury, 397 

mercuric iodide, 397 
oxide, 398 

precipitate, 398 

rose, 448 

wine, 143 

wines, light, 143 
Reduced iron, 404 
Resin, no 

of jalap, 536 

of podophyllum, 538 

of scammony, 537 
Resina jalapae, 536 

podophylli, 538 

scammonii, 537 
Resinse, no 
Resins, no, 316 
Resopyrin, 375 
Resopyrine, 295 
Resorcinol, 294 

Respiratory mucous membranes, drugs 
acting on, 553 

tract, applications of drugs to, 43 
Rhamnus Purshiana, 522 
Rhei, 529 
Rheum, 529 
Rhois glabrae, 448 

toxicodendri, 329 
Rhubarb, 529 

aqueous, 102 

vinous, 103 
Rhus glabra, 448 

toxicodendron, 329 
Risus sardonicus, 230 
Rochelle salt, 539 
Rodagen, 605 
Rosa gallica, 448 
Rotulae, 124 
Rubefacients, 587 
Rubijervine, 263 
Rubus, 449 
42 



Rue, 550 

Rum, 143 

Russian licorice root, peeled, 80 

Ruta, 550 

Rutin, 347 



Sabal, 358 

Sabina, 549 

Saccharal, 585 

Saccharated ferrous carbonate, 404 

oxide of iron, 78 
Saccharin, 585 
Saccharinol, 585 
Saccharinose, 585 
Saigon, 85 

cassia, 331 

cinnamon, 331 
Salacetol, 313 
Salacetolum, 177 
Sales effervescentes, 115 
Salicin, 313 
Salicinum, 313 
Salicylamid, 313 

Salicylated powder of talcum, 115 
Salicylic acid, 308 
Salicylphenetidin, 381 
Salifebrin, 313 
Saliformin, 568 
Salinaphthol, 297 
Saline waters, 474 
Saliphenin, 381 
Salipyrin, 375 
Salipyrine, 313 
Salocoll, 381 
Salol, 312 
Salophen, 313 
Saltpetre, 463 
Salt solutions, alkaline, 68 
Salts, 280, 450 

effervescent, 115 

non-effervescent, 116 
Salumin, 431 
Salveol, 294 
Sandalwood oil, 351 
Sanguinal, 408 
Sanguinaria, 558 
Sanguinariae, 79 
Sanguinarine, 558 
Sanguiniform, 408 
Santonica, 542 
Santonin, 542, 543 
Santoninum, 543 
Sapocarbol-cresolin, 294 
Saponin, 581 
Saprol, 294 
Sarsaparilla, 581 
Sarsa-saponin, 581 
Sassafras medulla, 601 

pith, 601 
Sassy bark, 248 
Savine, 549 
Scammonium, 537 
Scammony, 537 



6 5 8 



GENERAL INDEX. 



Scilla, 246 
Scillin, 246 
Scillipicrin, 246 
Scillitoxin, 246 
Sclerotinic acid, 249 
Scoparin, 225 
Scoparius, 225 
Scopola, 208 
Scopolamine, 207 

hydrobromide, 208 

hydrobromidum, 208 
Sebadilla, 263 
Sedatives, gastric, 506 
Seidlitz powder, 113, 452, 540 
Senega, 557 
Senegin, 557 
Senna, 531 

aromatic, 79 

compound, 79 
Serpentaria, 495 
Serum antidiphthericum, 610 

antistreptococcic, 613 
Serum -therapy, 607 
Sherry wine, 143 
Shot-gun prescriptions, 617 
Siddhi, 191 
Signature, 616 
Silver, 426 

cyanide, 426 

nitrate, 426 

oxide, 427 
Simple bitters, 493 

purgatives, 526 
Sinalbin, 322 
Sinapis alba, 321 

nigra, 321 
Sinigrin, 322 

Skin, administering drugs by, 41 
Slippery elm, 600 
Smith's solution of bromine, 70 
Soap liniment, 359 
Soaps, carbolic, 294 
Soda, 591 

mint, 90 
Sodii acetas, 452 

arsenas, 390 
exsiccatus, 390 

benzoas, 305 

bicarbonas, 452 

bisulphis, 282 

boras, 487 

bromidum, 194 

carbonas monohydratus, 452 

citras, 453 

hydroxidum, 591 

hypophosphis, 387 

iodidum, 467 

nitras, 465 

nitris, 270 

phenolsulphonas, 302 

phosphas, 540 
effervescens, 53, 540 
exsiccatus, 453, 540 

pyrophosphas, 540 



Sodii salicylas, 308 

sulphas, 540 

sulphis, 282 

thiosulphas, 283 
Sodiosalicylate of theobromine, 565 
Sodium acetate, 452 

anhydromethylene citrate, 568 

arsenate, 390 

benzoate, 305 

bicarbonate, 452 

bisulphite, 282 

borate, 487 

bromide, 194, 197 

chloride, 450 

citrate, 453 

hydroxide, 591 

hypophosphite, 387 

iodide, 467 

nitrate, 465 

nitrite, 270 

orthophosphate, 540 

phenolsulphonate, 302 

phosphate, 540 

salicylate, 308 

salts, 450 

sulphate, 540 

sulphite, 282 

sulphocarbolate, 302 

thiosulphite, 283 
Solid extracts, 108 

mixtures for internal use, 111 

opodeldoc, 126 
Soluble ferric phosphate, 406 
pyrophosphate, 407 

iron and quinine citrate, 405 

saccharated iron, 78 

saccharin, 585 
Solution of ammonium acetate, 572 

of arsenic and mercuric iodide, 390, 

397 
of arsenous acid, 389 
of basic ferric sulphate, 407 
of boroglyceride, 487 
of calcium hydroxide, 455 
of chlorinated potassa, 71 

soda, 285 
of ferric chloride, 405 

subsulphate, 407 

sulphate, 407 
of ferrous chloride, 70 
of formaldehyde, 314 
of hydrogen dioxide, 277 
of iodide of mercury and potassium, 70 
of iron and ammonium acetate, 405, 

572 
of lead subacetate, 415 
of magnesium citrate, 457, 539 
of mercuric nitrate, 398 
of oxysulphuret of calcium, 70 
of potassium arsenite, 389 

citrate, 455 

hydroxide, 453 
of saccharin, 72 
of sodium arsenate, 390 



GENERAL INDEX. 



659 



Solution of sodium hydrate, 451 
hydroxide, 451 
of zinc chloride, 593 
Solutions, 65, 67 

of metallic compounds, 69 
Solutol, 294 
Somnal, 141 
Sozal, 431 
Sozoiodal, 286 
Spanish flies, 318 
Sparkling wines, 143 
Sparteines sulphas, 225 
Sparteine, 225 

sulphate, 225 
Spearmint, 340 

water, 340 
Specific therapeutics, 29 
Sphacelic acid, 249 
Sphacelotoxin, 249 
Spigelia, 227, 544 
Spigeline, 544 
Spinal analgesia, 217 
Spirit of ammonia, 272 
of anise, 330 
of ants, 74 
of camphor, 359 
of chloroform, 159 
of cinnamon, 332 
of ether, 154 
of gaultheria, 314 
of glyceryl trinitrate, 270 
of juniper, 349 
of lavender, 338 
of mindererus 572 
of mustard, 74 
of nitroglycerin, 270 
of nitrous ether, 573 
of peppermint, 339 
of soap, 74 
of spearmint, 340 
Spirits, 73 
Spiritus, 73 
setheris, 154 

eompositus, 154 
nitrosi, 573 
ammonise, 272 

aromaticus, 272, 457 
anisi, 330 

aurantii eompositus, 330 
camphoras, 359 
chloroformi, 159 
cinnamomi, 332 
f rumen ti, 142 
gaultheriae, 314 
glycerylis nitratis, 270 
juniperi, 349 

eompositus, 333, 334, 349 
lavandulae, 338 
menthae piperita?, 339 

viridis, 340 

mindererus, 68 

rectificatus, 143 

vini gallici, 142 

Spirochaeta pallida, 613 



Spleen mixture, 90 
Spongiopiline, 136 
Spotted hemlock, 219 
Springs, list of, 474 
Squibb's diarrhea mixture, 89 
podophyllum pills, 123 
rhubarb mixture, 90 
Squill, 246 

Statistical therapeutics, 29 
St. Germain tea, 96 
Stillingia, 582 

St. John Long's liniment, 126 
Stokes' expectorant, 89 

liniment, 126 
Stomach, administration of drugs by, 44 
Stovaine, 218 
Stramonium, 210 
Stronger ammonia water, 272 
Strontii bromidum, 194 

iodidum, 467 
Strontium bromide, 194, 197 

iodide, 467 
Strophanthin, 243 
Strophanthinum, 243 
Strophanthus, 243 
Strychnina, 227 
Strychninae nitras, 228 

sulphas, 228 
Strychnine, 227 
group, 226 
nitrate, 228 
sulphate, 228 
Strychnos ignatia, 227 
Styptic collodion, 439 
Sublimed sulphur, 524 
Subscription, 616 
Sudorifics, 569 
Sugar of lead, 414 
Suggestion therapy, 24 
Sulphaminol, 286 
Sulphocyanate of acrinyl, 322 
Sulphomethane, 167 
Sulphomethanum, 167 
Sulphonal, 140, 167 
Sulphonethylmethane, 169 
Sulphonethylmethanum, 169 
Sulphur derivatives of alcohol, 167 
iodide, 467 
lotum, 524 
ointment, 524 
praecipitatum, 524 
sublimatum, 524 
Sulphuretted waters, 474 
Sulphuric acid, 477 
Sulphuris iodidum, 467 
Sulphurous acid, 280 
Sumach, 448 
Sumbolic acid, 585 
Sumbul, 584 
Sun mixture, 88 
Superscription, 616 
Suppositoria, 133 

glycerini, 596 
Suppositories, 44, 133 



66o 



GENERAL INDEX. 



Suppositories of glycerin, 596 
Suprarenal glands, 607 
Sweet flag, 337 

spirit of nitre, 74, 573 

wines, 143 
Sylvacrol, 582 
Syrup of acacia, 600 

of calcium lactophosphate, 482 

of citric acid, 484 

of Dover's powder, 78 

of ferrous iodide, 404 

of ginger, 346 

of hydriodic acid, 466 

of hypophosphites, 388 

of iodide of iron, tasteless, 78 

of ipecac, 511 

of krameria, 445 

of lactucarium, 191 

of lime, 455 

of manna, 79 

of morphine, 79 

of phosphates of iron, quinine, and 
strychnine, 406 

of rhubarb, 529 

of senega, 557 

of senna, 532 

of squill, 246 

of tar, 356 

of tolu, 355 

of wild cherry, 495 
Syrupi, 74 
Syrups, 74 
Syrupus acacias, 600 

acidi citrici, 484 
hydriodidi, 466 

calcii lactophosphatis, 482 

calcis, 455 

corrigens, 77 

ferri iodidi, 404 

quininae et strychninse phosphatum, 
406 

hypophosphitum, 388 
compositus, 388 

ipecacuanhae, 511 

krameriae, 445 

lactucarii, 191 

picis liquidae, 356 

pruni Virginianae, 495 

rhei, 529 

aromaticus, 529 

sarsaparillae compositus, 330, 532, 581 

scillac, 246 

compositus, 246, 509, 557 

senegas, 557 

sennas, 532 

spinas cervinas, 79 

solutanus, 355 

zingiberis, 346 
Systemic antiemetics, 506 



Tablet triturates, 

Tablets, 124 

Taeniae, 541 



Taka-diastase, 501 
Talc, 602 
Talcum, 602 

purificatum, 602 
Tanacetum, 551 
Tannal, 431 
Tannalbin, 441 
Tannic acid, 439 
Tannigen, 441 
Tannocol, 441 
Tannoform, 441 
Tannon, 441, 568 
Tannopin, 441, 568 
Tansv, 551 
Tar, 86, 98, 356 

alkaline, 71 

compound ointment, 131 

mixture, 90 

ointment, 356 
Taraxacin, 526 
Taraxacum, 526 
Tartar emetic, 508 
Tartaric acid, 484 
Tartrated antimony, 508 
Tasteless syrup of iodide of iron, 78 

tincture of iron, 97, 101 
Teas, 95 

Temple sleep, 24 
Tenacetin 551 
Terebene, 327 
Terebenum, 327 
Terpenes, 316 
Terpin hydrate, 328 
Terpini hydras, 328 
Terpinol, 328 
Tetrachlormethane, 163 
Tetronal, 140, 169 
Thalline, 367 
Thebaine, 227 
Theobroma cacao, 210 
Therapeutics, 23 

empirical, 28 

physiological, 29 

rational, 29 

specific, 29 

statistical, 29 
Therapy, dietetic, 26 

physicomcchanical, 26 

suggestion, 24 
Thielemann's mixture, 89 
Thioform, 435 
Thiol, 303 
Thiolum, 303 
Thioresorcin, 295 
Thiosinamine, 324 

Thompson's solution of phosphorus, 71 
Thorn-apple, 210 
Thymacetin, 340 
Thvmoform, 340 
Thymol 2S6, 340 

iodide, 340 
Tlivmolis iodidum, 340 
Thymosalol, 340 
Thymotal, 340 



GENERAL INDEX. 



661 



Thymus gland, 606 
Thyreoidectin, 605 
Thyroglandine, 605 
Tinctura aconiti, 260 
aloes, 527 

et myrrhae, 334, 527 
asafcetidae, 359 
belladonnas foliorum, 200 
benzoini, 305 

composita, 305, 355, 527 
calendulae, 494 
calumbae, 494 
cannabis indicae, 191 
cantharidis, 319 
capsici, 342 
cardamomi, 337 
# composita, 331, 334, 337 
cinchonas, 366 

composita, 366, 495 
cinnamomi, 331 
colchici seminis, 579 
digitalis, 236 
ferri chloridi, 405 
gallae, 442 

gambir composita, 331, 444 
gelsemii, 223 
gentianae composita, 493 
guaiac, 583 

guaiaci ammoniata, 583 
hydrastis, 233 
hyoscyami, 208 
iodi, 465 

ipecacuanhas et opii, 179, 512 
kino, 444 
kramerias, 445 
lactucarii, 191 

lavandulas composita, 331, 338, 344 
lobelias, 515 
myrrhae, 334 
nucis vomicae, 227 
opii, 179 

camphorata, 179, 330, 359 

deodorati, 179 
physostigmatis, 575 
quassiae, 493 
rhei, 529 

aromatica, 529 
sanguinariae, 558 
scillas, 246 
serpentarias, 495 
strophanthi, 243 
tolutana, 355 
Valerianae, 360 

ammoniata, 360 
zingiberis, 346 
Tincturas, 98 
arnicas, 267 

herbarum recentium, 98 
Tincture of aconite, 260 
of aloes, 527 

and myrrh, 527 
of arnica, 267 
of asafetida, 359 
of belladonna leaves, 200 



Tincture of benzoin, 305 

of calendula, 494 

of calumba, 494 

of cantharides, 319 

of capsicum, 342 

of cardamom, 337 

of cinchona, 366 

of cinnamon, 331 

of colchicum seed, 579 

of deodorized opium, 179 

of digitalis, 236 

of Dover's powder, 179 

of ferric chloride, 405 

of gelsemium, 223 

of ginger, 346 

of guaiac, 583 

of hydrastis, 233 

of hyoscyamus, 208 

of Indian cannabis, 191 

of iodine, 465 

of ipecac and opium, 179, 512 

of kino, 444 

of krameria, 445 

of lactucarium, 191 

of lavender, 344 

of lobelia, 515 

of myrrh, 334 

of nutgall, 442 

of nux vomica, 227 

of opium, 179 

of physostigma, 575 

of quassia, 493 

of rhubarb, 529 

of sanguinaria, 558 

of serpentaria, 495 

of squill, 246 

of strophanthus, 243 

of tolu, 355 

of valerian, 360 
Tinctures, 98 

of aloes and myrrh, 334 
Tolu, soluble, 103 
Topical remedies, 587 
Toxicology, 28 
Tragacanth, 601 
Tragacantha, 601 
Treatment, 23 
Trichloracetic acid, 592 
Trichloraldehyde, 141 
Trichloramidethylic alcohol, 176 
Tricresol, 293, 294 
Trional, 140, 169 
Trioxy benzols, 295 
Triplex pills, 124 
Trituratio elaterini, 534 
Trituration of elaterin, 534 
Triturations, in 
Troches, 112, 117 

of ammonium chloride, 554 

of cubeb, 352 

of gambir, 444 

of krameria, 445 

of liquorice and opium, 179 

of potassium chlorate, 490 



662 



GENERAL INDEX. 



Troches of santonin, 543 

of sodium bicarbonate, 452 

of tannic acid, 439 
Trochisci, 117 

acidi tannici, 439 

ammonii chloridi, 554 

cubebae, 352 

gambiris, 444 

glycyrrhizae et opii, 179, 330 

krameriffi, 445 

potassii chloratis, 490 

santonini, 543 

sodii bicarbonatis, 452 
Tropacocaine, 211, 217 
Troy pound. 60 
Troy weight, 59 
Tully's powder, 113, 179 
Tumenol, 303 
Tumenolum, 303 
Turlington's balsam, 99 
Turner's cerate, 131 
Turpentine liniment, 324 



Ulmus, 600 

Uncinaria, 541 
Unguenta, 129 
Unguentum, 603 

acidi borici, 487 
tannici, 439 

belladonnas, 201 

camphoratum, 131 

diachylon, 415 

gallae, 442 

hydrargyri, 397 
ammoniati, 396 
dilutum, 397 
nitratis, 398 
oxidi flavi, 398 
rubri, 398 

iodi, 465 

iodoformi, 285 

matris, 131 

phenolis, 289 

picis liquidae, 356 

potassii iodidi, 466 

sulphuris, 524 

veratrinae, 263 

zinci carbonatis impuri, 131 
oxidi, 421 
Ural, 141, 176 
Uralium, 176 
Urethane, 140, 165 
Urethra, application of drugs to, 44 
Uritone, 568 
Urotropin. 568 

salicylate, 568 
Urotropine, 315, 567 
Urzone, 348 

Uterus, drugs acting on, 548 
Uva ursi, 348 



[NATION, 42 



Valerian. 360 
Valeriana, 360 
Valerianic acid, 585 
Vallet's mass, 118, 101 
Vasoconstrictors, drugs acting as, 248 
Vasodilators, 268 
Vegetable astringents, 439 
Velpeau's diarrhea mixture, 89 
Veratrina, 263 
Veratrine, 263 

ointment, 263 
Veratrinej ervine, 263 
Veratrum, 263 

album, 263 
Vermicides, 541 
Vermifuges, 541 
Veronal, 140, 165 
Vesicants, 318 
Viburnum opulus, 584 

prunifolium, 583 
Villate's solution, 88 
Vina, 96 
Vinegar of opium, 178 

of squill, 246 
Vinegars, 96 
Vinum album, 97, 112 

antimonii, 509 

cocae, 211 

colchici seminis, 579 

ergotas, 249 

ferri, 405 

amarum, 406 

ipecacuanhae, 512 

opii, 179 

rubrum, 143 
Vioform, 286 
Virginia snakeroot, 495 
Vlemingkx's solution, 70 
Volatile oil of mustard, 322 

oils, 316 



Wafer, 113 
Wahoo, 83, 530 
Warburg's pills, 122 

tincture, ior 
Warren's styptic, 127 
Washed sulphur, 524 
Washes, 127 
Water, chloroform, 67 
Waters, aromatic, 67 

chemical, 67 

medicated, 67 
Weights and measures, 59 

metric table of, 62 
Whisky, 142 
White 'ash, 98 

hellebore, 263 

mustard, 321 

oak, 443 

petrolatum, 131, 598 

and hydrous wool-fat, 131 

pine compound, 70 

wine, 142 



GENERAL INDEX. 



663 



Wild cherry, 94, 98, 495 

ferrated, 98 
Wilkinson's ointment, 132 
Wine measure, 59, 60 

of antimony, 509 

of coca, 211 

of colchicum seed, 579 

of ergot, 249 

of ipecac, 512 

of iron, 405 

of opium, 179 

port, 143 

red, 143 

sherry, 143 

white, 142 
Wines, 96 

dry acid, 143 

light red, 143 

sparkling, 143 

sweet, 143 
Witch-hazel, 446 
Wool-fat, 598 
Woorari, 222 



Xanthine derivatives, 
Xanthopuccin, 232 
Xanthoxylum, 588 
Xeroform, 435 



256 



Yellow iodide of mercury, 397 
jasmine, 223 
mercuric oxide, 397 



Yellow mercurous iodide, 397 

wash, 127, 398 
Yerba santa, 77 
Young's rule for dosage, 47 



Zedoary compositus, 103 
Zinc, 420 

acetate, 420 

bromide, 19-4, 197 

chloride, 420, 593 

iodide, 420, 467 

oxide, 420 

phenolsulphonate, 420 

stearate, 421 

sulphate, 421 

sulphocarbolate, 302 

valerate, 360 
Zinci acetas, 420 

bromidum, 194 

carbonas praecipitatus, 420 

chloridum, 420, 593 

iodidum, 420, 467 

oxidum, 420 

phenolsulphonas, 420 

stearas, 421 

sulphas, 421 

sulphocarbolas, 302 

valeras, 360, 421 
Zincum, 420 
Zingiber, 346 
Zingiberis, 73 
Zucrol, 585 



CLINICAL INDEX. 



Abortion, to Prevent — 

Black haw, 584 
Abrasions — 

Potassium nitrate, 464 
Abscess — 

Calcium phosphate, 388 

Cocaine, 216 

Cod-liver oil, 504 

Phytolacca, 266 

Solution of ammonium acetate, 573 
Absorption of Inflammatory Exu- 
dates — 

Rubefacients, 587 
Accommodation, Paralysis of — 

Eserine, 577 
Acidity of Stomach — 

Ammonium preparations, 274 
Acne — 

Arsenic, 394 

Ichthyol, 304 

Pyrogallic acid, 442 

Quinine, 372 

Salicylic acid, 310 

Sulphur, 525 
Acne Rosacea — 

Bismuth subnitrate, 436 

Ergot, 252 

Hamamelis, 447 

Ichthyol, 304 

Resorcin, 295 
Aconite-poisoning — 

Belladonna, 207 
Addison's Disease — 

Suprarenal extract, 255, 256 
Adenitis — 

Camphorated naphthol, 298 

Colloidal silver, 430 

Pilocarpine, 572 

Potassium iodide, 471 
After-pains — 

Black haw, 584 

Camphor, 363 
Alcoholic Tremor — 

Cocaine, 217 
Alcoholism — 

Aromatic spirit of ammonia, 274 

Cocaine, 217 

Coffee, 259 

Lupulin, 190 

Solution of ammonium acetate, 573 

Strychnine, 231 
Alopecia — 

Aqua ammoniae, 274 



Alopecia — 

Capsicum, 342 

Nutgall ointment, 442 

Pilocarpine, 571 

Quinine, 371 

Savine, 550 

Tannic acid, 440 

Tincture of cantharides, 321 

Turpentine, 326 
Amaurosis — 

Strychnine, 231 
Amblyopia — 

Pilocarpine, 571 
Amenorrhea — 

Aloes, 528 

Apiol, 551 

Blood-root, 559 

Ergot, 252 

Guaiac, 583 

Manganese dioxide, 413 

Oil of savine, 550 

Quinine, 372 

Senega, 558 

Tansy, 551 

Tincture of cantharides, 321 
Anal Fissure — 

Belladonna ointment, 206 

Chloral, 173 

Cocaine, 216 

Fluidextract of hydrastis, 234 

Geranium, 448 

Glycerin, 597 

Iodoform, 288 

Krameria, 445 

Sulphur, 526 

Tannic acid, 440 

Tincture of iodine, 470 

White oak, 443 

Zinc oxide, 422 
Anal Ulcers — 

Red rose, 449 
Anemia — 

Arsenic, 394, 395 

Arsenite of copper, 426 

Bone-marrow, 607 

Cod-liver oil, 504 

Copper, 426 

Digitalis, 241 

Iron, 411 

Manganese, 414 

Nuclein, 607 

Phosphoric acid, 481 

Phosphorus, 386 



665 



666 



CLINICAL INDEX. 



Anemia — 

Potassium permanganate, 279 

Strychnine, 231 

Suprarenal extract, 255 
Aneurism — 

Aconite, 263 

Digitalis, 242 

Diuretin, 566 

Ergotin, 252 

Iodides, 471 
Angina of Scarlet Fever — 

Capsicum, 342 
Angina Pectoris — 

Amyl nitrite, 271 

Arsenic, 395 

Chloral, 174 

Ether, 156 

Phosphorus, 386 
Anorexia — 

Bitters, 497 
Anthrax — 

Serum-therapy, 613 
Aortic Insufficiency — 

Adonidin, 248 
Apepsia — 

Pepsin, 498 
Aphonia — 

Alum, 433 

Blisters, 318 

Nitric acid, 481 

Potassium dichromate, 490 
Aphthag — 

Magnesia, 462 

Saccharin, 586 

Sodium bicarbonate, 461 

Sodium phenolsulphonate, 302 
Aphthous Ulceration — 

Potassium chlorate, 492 
Apoplexy — 

Croton oil, 534 
Arrhythmia — 

Nitroglycerin, 271 
Arsenical Poisoning — 

Lime water, 462 
Arterial Tension, Low — 

Digitalis, 241 

Sodium nitrite, 271 
Arteriosclerosis — 

Diuretin, 566 

Nitroglycerin, 272 
Arthritic Effusion — 

Tincture of iodine, 470 
Arthritis — 

Cod-liver oil, 504 

Piperazin, 568 
Arthritis, Rheumatoid — 

Arsenic, 395 

Colchicum, 580 

Salicylic acid, 311 
Ascaris — 

Carbolic acid, 293 

Santonin, 544 
Ascaris Lumbricoides 

Oil of American wormsecd, 542 



Ascaris Lumbricoides — 

Spigelia, 544 
Ascites — 

Colchicum, 581 

Colocynth, 536 

Diuretin, 566 

Elaterin, 535 

Resin of copaiba, 351 
Asiatic Cholera — 

Calomel and opium, 402 

Chloral, 362 
Aspergillus — 

Salicylic acid, 310 
Asphyxia — 

Alcohol, 151 

Mustard, 323 
Asthenopia — 

Eserine, 577 
Asthma — 

Adonidin, 248 

Amyl nitrite, 271 

Antipyrine, 375 

Arsenic, 394, 395 

Belladonna, 206 

Bromides, 198 

Caffeine, 259 

Chloral, 174 

Cocaine, 217 

Colchicum, 580 

Grindelia, 354 

Hyoscyamus, 209 

Iodides, 471 

Ipecac, 514 

Lobelia, 516 

Nitre -paper, 464 

Opium, 186 

Physostigma, 578 

Pilocarpine, 571 

Potassium iodide, 471 

Quinine, 372 

Stramonium, 210 

Strychnine, 231 
Atheroma — 

Cod-liver oil, 504 
Auditory Canal, Diseases of — 

Solution of chlorinated soda, 285 
Aural Catarrh — 

Ammonium chloride, 555 
Aural Ulcers — 

Red rose, 449 



Balanitis — 

Alumnol, 297 
Silver nitrate, 429 
Bedsores — 

Balsam of Peru, 355 
Demulcents, 595 
Emollients, 595 
Glycerin, 597 
Protectives, 595 
Silver nitrate, 428 
Tannic acid, 440 



CLINICAL INDEX. 



667 



Belladonna -poisoning — 

Pilocarpine, 572 
Biliary Calculi — 

Opium, 187 

Sodium phosphate, 541 
Biliousness — 

Calomel, 402 

Citric acid, 485 

Rochelle salt, 541 

Seidlitz powder, 541 

Senna, 532 

Solution of magnesium citrate, 541 
Bites of Insects — 

Ammonia water, 274 

Olive oil, 598 
Bites of Rabid Animals — 

Carbolic acid, 292 

Sulphuric acid, 480 
Black Eye- 
Alum, 432 
Bladder Affections — 

Betol, 298 
Bladder, Catarrh of — 

Thymol, 341 

Tincture of cantharides, 321 
Bladder, Debility of— 

Tincture of cantharides, 321 
Bladder, Hemorrhage From — 

Hamamelis, 447 
Bladder, Spasm of — 

Cannabis, 193 
Blepharitis Marginalis — 

Yellow oxide of mercury, 401 
Blistering Skin — 

Glacial acetic acid, 592 
Blisters — 

Savine, 550 

Zinc carbonate, 423 
Boils- 
Belladonna ointment, 206 

Cantharidal blister, 320 

Colloidal silver, 430 

Glycerin, 597 

Menthol, 339 

Silver nitrate, 428 

Tar, 357 
Brain, Congestion of — 

Elaterin, 535 
Brain, Diseases of — 

Cantharidal blister, 321 
Bright's Disease — 

Alkalies, 462 

Cod-liver oil, 504 

Digitalis, 242 

Iron, 411 

Pilocarpine, 571 

Scoparius, 226 

Spirit of nitrous ether, 574 

Strophanthin, 244 
Bromidrosis — 

Chloral, 173 

Potassium permanganate, 279 
Bronchial Asthma — 

Strychnine, 231 



Bronchial Secretion, Excessive- 
Oil of turpentine, 326 
Bronchitis — 

Acetanilid, 378 

Alcohol, 151 

Alum, 433 

Ammonium carbonate, 274 

Ammonium chloride, 555 

Ammonium iodide, 471 

Ammonium preparations, 463 

Apomorphine, 508 

Arsenic, 394, 395 

Asafetida, 362 

Balsam of Peru, 355 

Balsam of tolu, 356 

Belladonna, 206 

Benzoic acid, 307 

Buchu, 347 

Calomel, 402 

Cannabis, 193 

Cerium oxalate, 438 

Cod-liver oil, 504 

Colchicum, 580 

Copaiba, 351 

Creosote, 300 

Demulcents, 595 

Digitalis, 241 

Diuretics, 564 

Eucalyptus, 336 

Grindelia, 354 

Hedeoma, 552 

Iodides, 471 

Ipecac, 513, 514 

Lime water, 462 

Liquorice, 556 

Lobelia, 516 

Myrrh, 335 

Nitric acid, 481 

Oil of turpentine, 326 

Opium, 186 

Physostigma, 578 

Potassium iodide, 471 

Sanguinaria, 559 

Senega, 558 

Serpentaria, 497 

Sodium hyposulphite, 283 

Squill, 247 

Strychnine, 231 

Sulphur, 526 

Tar, 358 

Tartar emetic, 511 

Terebene, 328 

Terpin hydrate, 328 

Turpentine, 327 

Wild cherry, 497 
Bronchopneumonia — 

Ammonium carbonate, 274 
Broncho -pulmonary Disorders- 
Thymol, 341 
Bronchorrhea— 

Alum, 433 

Asafetida, 362 

Carbolic acid, 292 

Copaiba, 351 



668 



CLIXICAL INDEX. 



Bronchorrhea — 

Eucalyptus, 336 

Lead acetate, 419 

Myrrh, 335 

Pilocarpine, 571 

Senega, 558 

Terebene, 328 

Turpentine, 327 

Zinc oxide, 422 
Bruises — 

Ammonium chloride, 555 

Arnica, 267 

Camphor liniment, 362 

Hamamelis, 447 

Liquor plumbi subacetatis, 419 

Olive oil, 598 

Potassium nitrate, 464 

Tansy, 551 
Buboes — 

Ammonium chloride, 555 

Hydrogen dioxide, 277 

Iodoform, 288 

Phytolacca, 266 

Salol, 312 

Tincture of iodine, 470 
Buccal Ulcer — 

Geranium, 448 

Red rose, 449 
Burns — 

Acacia, 6co 

Bismuth subgallate, 436 

Bismuth subnitrate, 436 

Carbolic acid, 292 

Hamamelis, 447 

Lime water, 467 

Linseed oil, 599 

Menthol, 339 

Xutgall ointment, 442 

Ointment of rose, 449 

Olive oil, 598 

Phytolacca, 266 

Protectives, 595 

Rhus toxicodendron, 330 

Salol, 312 

Sodium bicarbonate, 461 

Zinc oxide, 422 



Cachexia, Mercurial — 

Iodine, 471 
Calculi- 
Ammonium benzoate, 307 
Calculi, Biliary — 

Opium, 187 

Sodium phosphate, 541 
Calculi, Renal — 

Diuretics, 546 

Opium, 187 
Calculi, Vesical — 

Piperazin, 568 
Callositas — 

Salicylic acid, 310 
Cancer — 

Arsenic, 393 



Cancer — 

Bromine, 594 

Carbolic acid, 292 

Conium, 221 

Podophyllum, 538 

Sulphuric acid, 480 

Zinc chloride, 593 
Cancer, Gastric — 

Arsenic, 395 

Pepsin, 498 
Cancer of Cervix — 

Xitric acid, 480 
Cancer of Tongue — 

Potassium permanganate, 279 
Cancer of Uterus — 

Chloral, 173 

Iodoform, 288 

Potassium permanganate, 279 

Tannic acid, 440 
Cancer of Vagina — 

Potassium permanganate, 279 
Cancrum Oris — 

Bismuth subnitrate, 436 

Zinc sulphate, 423 
Capillary Bronchitis — 

Alcohol, 151 
Capillary Oozing — 

Alcohol, 150 
Carbuncle — 

Belladonna ointment, 206 

Cantharidal blister, 320 

Glycerin, 597 

Hamamelis, 447 

Serum -therapy, 613 
Cardiac Asthma — 

Adonidin, 248 
Cardiac Depression — 

Caffeine, 258 
Cardiac Diseases of Children — 

Strophanthin, 245 
Cardiac Dropsy — 

Caffeine, 258 

Casca bark, 248 

Digitalis, 242 

Diuretics, 563 

Potassium bitartrate, 462 

Scoparius, 226 

Squill, 247 
Cardiac Dyspnea — 

Amyl nitrite, 271 
Cardiac Hypertrophy — 

Aconite, 262 
Cardiac Irritability- 
Bromides, 198 
Cardiac Pain — 

Belladonna, 207 
Cardiopathies Associated With Neph- 
ritis — 

Caffeine, 258 

Nitroglycerin, 271 
Caries — 

Betanaphthol, 298 

Hydrochloric acid, 480 



CLINICAL INDEX. 



669 



Catarrh — 

Benzoin, 307 

Bismuth subnitrate, 436 

Borax, 489 

Boric acid, 489 

Compound tincture of benzoin, 307 

Potassium iodide, 471 

Potassium permanganate, 279 

Sodium phenolsulphonate, 302 

Suprarenal extract, 255 

Tar, 358 

Turpentine, 326 
Catarrh, Aural- 
Ammonium chloride, 555 
Catarrh, Duodenal — 

Sanguinaria, 559 

Sodium phosphate, 541 
Catarrh, Gastric — 

Bitters, 497 

Capsicum, 343 

Salicylic acid, 311 

Strychnine, 231 
Catarrh, Intestinal — 

Copaiba, 351 

Salol, 313 

Turpentine, 326 
Catarrh, Nasal — 

Bismuth oxide, 436 

Glycerin, 597 

Sodium bicarbonate, 461 
Catarrh, Vesical — 

Silver nitrate, 429 

Tar water, 358 

Thymol, 341 

Tincture of cantharides, 321 
Catarrhal Deafness — 

Iodine, vapor of, 470 
Catarrhal Jaundice — 

Citric acid, 485 

Pilocarpine, 572 

Salol, 313 
Catarrhal Pneumonia — 

Arsenic, 395 
Cellulitis— 

Digitalis, 241 
Cellulitis, Pelvic- 
Mercurial ointment, 401 
Cerebral Congestion — 

Colchicum, 581 
Cerebral Hyperemia — 

Belladonna, 207 

Ergot, 252 
Cerebral Vomiting — 

Ammonium bromide, 198 
Cerebrospinal Meningitis — 

Aconite, 263 

Alcohol, 151 

Blisters, 318 

Ergot, 252 

Gelsemium, 225 
Cerumen, Impacted — 

Glycerin, 597 

Liquor potassee, 461 

Papain, 500 



Cervical Glands, Enlargement of — 

Pilocarpine, 572 
Cervix, Cancer of — 

Nitric acid, 480 
Cervix, Erosion of — 

Glycerite of tannic acid, 597 
Cervix, Inflammation of — 

Tannic acid, 440 
Cervix, Ulcers of — 

Carbolic acid, 292 
Chafing of Skin — 

Lycopodium, 603 
Chancre — 

Acetanilid, 378 

Alumnol, 297 

Bismuth benzoate, 30S 

Bismuth subnitrate, 436 

Iodoform, 288 

Potassium dichromate, 490 

Sulphuric acid, 480 
Chancroids — 

Acetanilid, 378 

Bismuth benzoate, 307 

Carbolic acid, 292 

Iodoform, 288 

Potassium dichromate, 490 

Salicylic acid, 310 

Silver nitrate, 429 
Chapped Nipples — 

White oak, 443 
Chapping — 

Bismuth subnitrate, 436 

Camphor-ice, 362 

Compound tincture of benzoin, 307 

Glycerin, 597 

Ointment of rose, 449 

Tragacanth, 601 
Chilblains — 

Aconite, 262 

Alum, 433 

Ammonia liniment, 274 

Camphor liniment, 362 

Capsicum, 343 

Carbolic acid, 292 

Nutgall ointment, 442 

Rhus toxicodendron, 330 
Chloasma — 

Nitric acid, 480 

Tincture of iodine, 470 
Chloral -poisoning — 

Strychnine, 232 

Suprarenal extract, 256 
Chloroform -poisoning — 

Ammonia, 274 

Amyl nitrite, 271 

Atropine, 207 

Suprarenal extract, 256 
Chlorosis — 

Arsenic, 395 

Iron, 411 

Manganese, 414 

Pills of aloes and iron, 528 

Strychnine, 231 



670 



CLINICAL INDEX. 



Cholera- 
Bismuth subnitrate, 436 

Digitalis, 241 

Opium, 186 

Prepared chalk, 462 

Salicylic acid, 311 

Serum-therapy, 612 

Sulphuric acid, 481 
Cholera Infantum — 

Arsenite of copper, 426 

Bismuth subnitrate, 436 

Lead acetate, 419 
Cholera Morbus — 

Opium, 186 
Chordee — 

Camphor, 362, 363 

Cannabis, 193 
Chorea — 

Arsenic, 394 

Asafetida, 362 

Cocaine, 217 

Hyoscyamus, 209 

Quinine, 372 

Salicylic acid, 311 

Silver nitrate, 429 
Cinchonism — 

Diluted hydrobromic acid, 199 
Circumcision — 

Cocaine, 216 
Cirrhosis of Kidneys — 

Potassium iodide, 471 
Cirrhosis of Liver — 

Calomel, 402 

Diuretin, 566 

Podophyllum, 538 

Potassium iodide, 471 
Cocaine Habit — 

Iron, 411 
Colds- 
Aconite, 262 

Citric acid, 485 

Mustard bath, 323 

Pilocarpine, 572 
Colic— 

Asafetida, 362 

Belladonna, 206 

Camphor, 362 

Compound spirit of ether, 156 

Ginger, 347 

Hedeoma, 552 

Hyoscyamus, 209 

Tansy, 551 
Colic, Hepatic — 

Belladonna, 207 
Colic, Intestinal — 

Belladonna, 207 
Colic, Lead — 

Alum, 433 

Belladonna, 206 

Croton oil, 534 
Colic, Renal — 

Belladonna, 207 
Collapse — 

Alcohol, 151 



Collapse- 
Digitalis, 241 
Coma — 

Mustard, 323 
Comedo — 

Salicylic acid, 310 

Sulphur, 525 
Condyloma — 

Chromic acid, 590 

Resorcin, 295 
Congestion — 

Hedeoma, 552 
Congestion, Cerebral — 

Colchicum, 581 

Elaterin, 535 
Congestion, Hepatic — 

Calomel, 402 
Congestion of Kidneys — 

Juniper, 349 

Spirit of nitrous ether, 574 
Congestion of Lungs — 

Digitalis, 241 

Elaterin, 535 

Ergot, 252 
Congestion of Spine — 

Ergot, 252 
Congestion of Uterus — 

Glycerite of tannic acid, 597 
Congestion, Portal — 

Colchicum, 581 
Conjunctivitis — 

Alum, 432 

Bismuth subnitrate, 436 

Boric acid, 489 

Copper sulphate, 425 

Gallicine, 442 

Opium, 185 

Silver nitrate, 428 

Zinc acetate, 422 

Zinc sulphate, 423 
Constipation — 

Aloes, 528 

Asafetida, 362 

Belladonna, 206 

Cascara sagrada, 522 

Colocynth, 536 

Euonymus, 531 

Glycerin, 597 

Jalap, 537 

Manna, 524 

Physostigma, 578 

Podophyllum, 538 

Rhubarb, 530 

Senna, 532, 533 

Sodium salts, 541 

Strychnine, 231 

Sulphur, 526 

Taraxacum, 526 
Continued Fevers — 

Opium, 187 
Contusions — 

Alcohol, 150 

Solution of ammonium acetate, 573 

Tincture of calendula, 497 



CLINICAL INDEX. 



671 



Convalescence — 

Bitters, 497 

Cod-liver oil, 504 
Convulsions — 

Asafetida, 362 

Bromides, 198 

Chloral, 173 

Hyoscyamus, 209 
Cornea, Ulcer of — 

Eserin, 577 
Corns — 

Arsenous acid, 394 

Glacial acetic acid, 485, 592 

Potassium dichromate, 490 

Salicylic acid, 310 

Trichloracetic acid, 485 
Coryza — 

Ammonium chloride, 555 

Antipyrine, 375 

Arsenic, 395 

Belladonna, 206 

Camphor, 362 

Camphoric acid, 363 

Cocaine, 216 

Dover's powder, 187 

Glycerin, 597 

Iodine, vapor of, 470 

Salicylic acid, 310 

Solution of ammonium acetate, 573 
Cough — 

Asafetida, 362 

Benzoic acid, 307 

Bromides, 198 

Cerium oxalate, 438 

Cubeb, 353 

Grindelia, 354 

Ipecac, 513 

Lactucarium, 191 

Liquorice, 556 

Spirit of nitrous ether, 5 74 

Strychnine, 231 

Sumbul, 585 

Terebene, 327 

Turpentine, 326 
Cracked Lips — 

Balsam of Peru, 355 
Cracked Nipples — 

Balsam of Peru, 355 

Chloral, 173 
Croup — 

Copper sulphate, 425 

Papain, 500 

Pepsin, 498 

Senega, 558 

Silver nitrate, 429 

Zinc sulphate, 423 
Crusts, Removal of— 

Olive oil, 598 
Cystitis — 

Antipyrine, 375 

Belladonna, 207 

Benzoic acid, 307 

Borax, 489 

Boric acid, 489 



Cystitis — 

Buchu, 347 
Camphoric acid, 363 
Copaiba, 350 
Demulcents, 595 
Diuretics, 564 
Elm, 600 
Hamamelis, 447 
Hexamethylenamine, 568 
Hydrogen dioxide, 278 
Hyoscyamus, 209 
Lactic acid, 483 
Myrrh, 335 
Naphthalene, 297 
Piperazin, 568 
Quinine, 371 
Resorcin, 295 
Salol, 312 
Turpentine, 327 
Cysts, Sebaceous — 
Ether, 156 



Deafness — 

Iodine, vapor of, 470 
Debility of Bladder— 

Fluidextract of blackberry, 449 

Tincture of cantharides, 321 
Deglutition, Painful — 

Olive oil, 598 
Delirium of Fever — 

Diluted hydrobromic acid, 199 
Delirium Tremens — 

Aromatic spirit of ammonia, 274. 

Bromides, 198 

Chamomile, 497 

Chloral, 173 

Digitalis, 241 

Opium, 190 

Strychnine, 231 
Dental Caries — 

Betanaphthol, 298 
Dermatitis — 

Eucalyptus, 336 

Magnesium carbonate, 461, 523 
Dermatitis Herpetiformis — 

Thiol, 304 
Dermatitis Venenata — 

White oak, 443 
Diabetes Insipidus — 

Ergot, 252 

Lime water, 462 

Pilocarpine, 572 

Valerian, 363 
Diabetes Mellitus — 

Ammonium bromide, 198 

Antipyrine, 375 

Arsenic, 395 

Cod-liver oil, 504 

Lactic acid, 483 

Phosphoric acid, 481 

Piperazin, 568 

Saccharin, 586 

Strychnine, 232 



6 7 2 



CLIXICAL INDEX 



Diabetes Mellitus — 

Thymol, 341 

Valerian, 363 
Diarrhea — 

Alum, 433 

Arsenic, 395 

Arsenite of copper, 426 

Betanaphthol, 298 

Bismuth phosphate, 437 

Bismuth subgallate, 436 

Bismuth subnitrate, 436 

Bismuth tannate, 437 

Borax, 489 

Boric acid, 489 

Bromides, 198 

Caffeine, 259 

Calomel, 402 

Camphor, 362 

Casca bark, 248 

Cerium oxalate, 438 

Colchicum, 5S0 

Copaiba, 351 

Copper sulphate, 425 

Demulcents, 595 

Elm, 600 

Ergot, 252 

Fluidextract of blackberry, 449 

Fowler's solution, 395 

Geranium, 448 

Ginger, 347 

Haematoxylon, 446 

Ipecac, 514 

Kimo, 444 

Krameria, 445 

Lactic acid, 483 

Lead acetate, 419 

Lime water, 462 

Naphthalene, 297 

Opium, 188 

Pepsin, 498 

Prepared chalk, 462 

Quinine, 372 

Resorcin, 295 

Rhubarb, 530 

Salicylic acid, 311 

Silver nitrate, 429 

Sodium nitrate, 46; 

Sodium phenolsulphonate, 302 

Strychnine, 231 

Sulphuric acid, 481 

Tannic acid, 440 

Thymol, 341 

White oak, 443 

Zinc oxide, 422 

Zinc sulphate, 423 

Zinc sulphocarbolate. 302 
Digestion, Weakened — 

Alcohol, 150 
Digestive Disorders — 

Nuclein, 607 
Digestive Organs — Inflamed Condi- 
tions of — 

Althaea, 601 



Dilatation, Intestinal — 

Physostigma, 578 
Dilatation of Heart — 

Digitalis, 240 

Ergot, 252 
Dilatation of Stomach — 

Carbolic acid, 292 

Physostigma, 578 
Diphtheria — 

Alcohol, 150, 151, 152 

Alum, 433 

Balsam of Peru, 355 

Balsam of tolu, 356 

Betanaphthol, 298 

Chlorine water, 284 

Eucalyptus, 336 

Gallic acid, 441 

Hydrochloric acid, 480 

Hydrogen dioxide, 278 

Hyposulphites, 283 

Iron, 411 

Iron, tincture of chloride of, 411 

Papain, 500 

Pepsin, 498 

Potassium permanganate, 279 

Resorcin, 295 

Salicylic acid, 310, 311 

Serum-therapy, 6oq 

Sodium phenolsulphonate, 302 

Sulphur, 525 

Sulphurous acid, 28 2 

Tartaric acid, 485 

Thymol, 341 

Zinc sulphate, 423 
Dislocations — 

Ether, 156 
Dropsical Effusion — 

Diuretin, 566 

Salines, 541 
Dropsical Fluids — 

Diuretin, 566 
Dropsy — 

Caffeine, 258 

Casca bark, 248 

Digitalis, 242 

Diuretin, 566 

Jalap, 537 

Juniper, 349 

Potassium bitartrate, 462 

Potassium iodide, 471 

Resin of copaiba, 351 

Solution of ammonium acetate, 573 

Squill, 247 
Dropsy, Cardiac — 

Diuretics, 563 

Scoparius, 226 
Dryness of Mouth — 

Glycerin, 597 
Dryness of Throat — 

Pilocarpine, 571 
Duodenal Catarrh — 

Sanguinaria, 559 

Sodium phosphate, 541 



CLINICAL INDEX. 



t>73 



Dysentery — 

Alum, 433 

Bismuth phosphate, 437 

Bismuth subgallate, 436 

Bismuth subnitrate, 436 

Carbolic acid, 293 

Casca bark, 248 

Colchicum, 580 

Copaiba, 351 

Copper sulphate, 425 

Corrosive chloride of mercury, 402 

Demulcents, 595 

Elm, 600 

Ergot, 252 

Hsematoxylon, 446 

Hydronaphthol, 298 

Ipecac, 513 

Kino, 444 

Krameria, 445 

Lactic acid, 483 

Lead acetate, 419 

Lime water, 462 

Naphthalene, 297 

Olive oil, 598 

Opium, 186 

Quinine, 372 

Rhubarb, 530 

Silver nitrate, 429 

Sodium nitrate, 465 

Tannic acid, 440 

Thymol, 341 

White oak, 443 

Zinc oxide, 422 

Zinc sulphate, 423 
Dysmenorrhea — 

Acetanilid, 379 

Amyl nitrite, 271 

Apiol,_ 551 

Arsenic, 394 

Belladonna, 206 

Black haw, 584 

Blood-root, 559 

Camphor, 363 

Ergot, 252 

Gelsemium, 225 

Guaiac, 583 

Hydrastine, 234 

Manganese dioxide, 413 

Solution of ammonium acetate, 573 

Spirit of nitrous ether, 574 

Sumbul, 585 
Dyspepsia — 

Alcohol, 150 

Ammonium preparations, 461, 463 

Asafetida, 362 

Bismuth phosphate, 437 

Bitters, 497 

Carbolic acid, 292 

Casca bark, 248 

Cerium oxalate, 437 

Colchicum, 580 

Haematoxylon, 446 

Hydrochloric acid, 481 

Ipecac, 513 

43 



Dyspepsia — 

Lactic acid, 483 
Manganese sulphate, 414 
Myrrh, 335 
Nux vomica, 230 
Pepsin, 498 

Potassium dichromate, 490 
Quinine, 372 
Resorcin, 295 

Sodium phenolsulphonate, 302 
Strychnine, 230 
Sulphurous acid, 282 
Taraxacum, 526 
Terebene, 328 
Dyspnea — 

Amyl nitrite, 271 
Grindelia, 354 



Ear, Diseases of — 

Ammonium chloride, 555 

Aristol, 289 

Hydrogen dioxide, 278 

Ichthyol, 304 

Iodoform, 288 

Liquor potassae, 461 

Mercury, 401 

Nitric acid, 480 

Oil of peppermint, 339 

Opium, 185 

Pilocarpine, 572 

Sodium bicarbonate, 461 

Thymol, 341 

Turpentine, 326 
Earache — 

Oil of cloves, 345 
Ecchymoses — 

Tincture of arnica, 267 
Eclampsia, Puerperal — 

Amyl nitrite, 271 

Chloral, 174 

Veratrum viride, 265 
Ecthyma — 

Liquor plumbi subacetatis, 419 

Quinine, 372 

Sulphur, 525 
Eczema — 

Anderson's powder, 362 

Arsenic, 394 

Balsam of Peru, 355 

Belladonna, 206 

Bismuth subgallate, 436 

Black wash, 461 

Calomel, 401 

Carbolic acid, 292 

Cod-liver oil, 503 

Colchicum, 580 

Eucalyptus, 336 

Gallanol, 442 

Gallicine, 442 

Gelsemium, 225 

Glycerite of starch, 597 

Grindelia, 354 

Hamamelis, 447 



674 



CLINICAL INDEX. 



Eczema — 

Ichthyol, 304 

Lead acetate, 418 

Liquor plumbi subacetatis, 419 

Lycopodium, 603 

Menthol, 339 

Nutgall ointment, 442 

Papain, 500 

Phytolacca, 266 

Pilocarpine, 571, 572 

Plumbi iodide, 419 

Potassium chlorate, 492 

Prepared chalk, 461 

Resorcin, 295 

Salicylic acid, 310 

Salol, 312 

Sodium carbonate, 461 

Sulphur, 525, 526 

Tannic acid, 440 

Tar, 357 

Yellow wash, 461 

Zinc carbonate, 423 

Zinc oxide, 422 

Zinc sulphate, 422 
Edema of Prepuce — 

Glycerin, 597 
Emesis — 

Cerium oxalate, 437 
Emphysema — 

Physostigma, 578 

Terebene, 328 

Turpentine, 327 
Empyema — 

Hydrogen dioxide, 278 

Tincture of iodine, 470 
Endarteritis — 

Iodides, 471 
Endocarditis — 

Blisters, 318 

Quinine, 372 
Endocervicitis — 

Carbolic acid, 292 
Endometritis — 

Carbolic acid, 292 

Glycerite of tannic acid, 597 

Hydrogen dioxide, 278 

Tincture of iodine, 470 

Zinc chloride, 593 
Engorged Mammary Glands- 
Olive oil, 598 
Enlarged Lymphatic Glands — 

Plumbi iodide, 419 

Potassium iodide, 471 
Enlarged Spleen — 

Plumbi iodide, 419 
Enlarged Tonsils — 

Chromic acid, 590 

Zinc iodide, 423 

Zinc sulphate, 423 
Enlargement of Prostate Gland — 

Ergotin, 252 
Enlargement, Splenic — 

Ergot, 252 



Enteralgia — 

Belladonna, 206 

Hyoscyamus, 209 
Enteritis — 

Demulcents, 595 
Enterocolitis — 

Salicylic acid, 311 
Enuresis — 

Camphoric acid, 363 
Epididymitis — 

Ammonium chloride, 555 

Mercurial ointment, 401 
Epilepsy — 

Acetanilid, 379 

Amyl nitrite, 271 

Borax, 489 

Bromides, 198 

Chloral, 174 

Digitalis, 241 

Silver nitrate, 429 
Epistaxis — 

Acetanilid, 378 

Acetic acid, 485 

Alum, 432 

Ether, 156 

Geranium, 448 

Hamamelis, 447 

Kino, 444 

Krameria, 445 

Sulphuric acid, 480 
Epithelial Debris, Removal of — 

Olive oil, 598 
Epithelioma — 

Bismuth subnitrate, 436 

Nitric acid, 480 

Pyrogallol, 442 

Zinc chloride, 593 
Erosion of Cervix— 

Glycerite of tannic acid, 597 
Eruptive Fevers — 

Diuretics, 564 

Solution of ammonium acetate, 573 
Erysipelas — 

Alcohol, 152 

Belladonna, 207 

Bismuth subnitrate, 436 

Colloidal silver, 430 

Guaiacol, 301 

Hyposulphites, 283 

Ichthyol, 304 

Iron, 411 

Liquor plumbi subacetatis, 419 

Lycopodium, 603 

Pilocarpine, 571 

Prepared chalk, 461 

Quinine, 371 

Salicylic acid, 310 

Zinc oxide, 422 
Erythema — 

Anderson's powder, 362 

Bismuth subnitrate, 436 

Ergot, 252 

Lead acetate, 418 

Ointment of rose, 449 



CLINICAL INDEX. 



675 



Erythema— 

Thiol, 304 
Eye, Diseases of — 

Belladonna, 206 

Eserine sulphate, 577 

Hydrogen dioxide, 278 

Iodoform, 288 

Mercury, 401 

Physostigmine, 577 

Pilocarpine, 571, 572 
Eye, Inflammation of — 

Red rose, 449 

Suprarenal extract, 255 
Eyeball, Neuralgia of— 

Eserine, 577 
Exanthemata — 

Acetanilid, 378 

Acetic acid, 485 

Cod-liver oil, 503 
Exanthematous Fever — 

Camphor, 363 

Opium, 187 
Excoriations — 

Acacia, 600 

Glycerin, 597 

Olive oil, 598 

Tar, 357 
Exophthalmic Goiter — 

Belladonna, 207 

Bromides, 198 

Digitalis, 241 

Ergot, 252 



Facial Erysipelas — 

Belladonna, 207 
Fainting — 

Ammonia water, 274 
Fatigue — 

Rubefacients, 587 
Fatty Degeneration of Heart — 

Iodides, 471 
Fauces, Inflammation of — 

Salicylic acid, 310 

Silver nitrate, 429 
Favus — 

Carbolic acid, 292 

Gallanol, 442 

Hyposulphites, 283 

Phytolacca, 266 
Febrile Affections — 

Acacia, 600 

Aconite, 262 

Ammonium carbonate, 274 

Belladonna, 206 

Citric acid, 485 

Demulcents, 595 

Diuretics, 564 

Ipecac, 514 

Nitric acid, 481 

Opium, 187 

Potassium bromide, 198 

Potassium nitrate, 464 

Solution of ammonium acetate, 573 



Febrile Affections — 

Spirit of nitrous ether, 574 
Fecal Accumulation — 

Senna, 532 
Feces, Impacted — 

Oxgall, 529 
Feet, Sweating of — 
Plumbi oxidum, 419 
Felons — 
Cocain, 216 

Liquor plumbi subacetatis, 419 

Silver nitrate, 428 
Fermentation — 
Carbolic acid, 292 

Salicylic acid, 311 
Fermentation, Intestinal — 

Oxgall, 529 
Fetid Odor— 

Plumbi nitras, 419 
Fibroids, Uterine — 

Ergot, 252 
Fibrous Exudations, to Diminish — 

Sodium nitrate, 465 
Fissure — 

Bismuth subnitrate, 436 

Tannic acid, 440 
Fissure of Tongue — 

Glycerin, 597 
Fissure, Rectal — 

Hamamelis, 447 
Fissured Nipples — 

Compound tincture of benzoin, 307 

Glycerin, 597 

Nutgall ointment, 442 

Plumbi nitras, 419 

Tar, 357 

Zinc oxide, 422 
Fistula— 

Cantharidal blister, 320 

Cod-liver oil, 504 

Hydrogen dioxide, 277 

Iodoform, 288 
Fistula, Salivary — 

Chromic acid, 591 
Fistulous Discharges — 

Quinine, 372 
Fistulous Openings, to Dilate — 

Elm, 600 
Fistulous Tracts — 

Calcium phosphate, 388 
Flatulence — 

Alcohol, 151 

Anise, 331 

Asafetida, 362 

Camphor, 362 

Ginger, 347 

Physostigma, 578 

Salicylic acid, 311 

Spirit of nitrous ether, 574 

Turpentine, 326 
Flatulent Colic- 
Compound spirit of ether, 156 
Foul Discharges — 

Chlorine water, 284 



676 



CLINICAL INDEX. 



Foul-smelling Sores — 

Haematoxylon, 446 
Freckles — 

Powdered nitre, 464 
Frost-bite — 

Alcohol, 150 

Compound tincture of benzoin, 307 

Hamamelis, 447 
Fungoid Granulations — 

Nitric acid, 480 
Fungous Growths — 

Alumen exsiccatum, 433 



Galactorrhea — 

Ergot, 252 
Gall-stones — 

Olive oil, 599 
Gangrene — 

Ammonium chloride, 555 

Bromine, 594 

Carbolic acid, 292 

Haematoxylon, 446 

Nitric acid, 480 

Salicylic acid, 310 

Sodium hyposulphite, 283 

White oak, 443 
Gangrene of Lungs — 

Eucalyptus, 336 
Gangrene of Pharynx — 

Copper sulphate, 425 
Gangrenous Pharyngitis — 

Alum, 432 
Gangrenous Sores — 

Plumbi nitras, 419 

Solution of chlorinated soda, 285 
Gangrenous Stomatitis — 

Zinc sulphate, 423 
Gastralgia — 

Acetanilid, 379 

Alcohol, 151 

Arsenic, 395 

Belladonna, 206 

Bismuth phosphate, 437 

Coca, 216 

Compound spirit of ether, 156 

Manganese dioxide, 413 

Menthol, 339 

Resorcin, 295 

Silver nitrate, 429 

Silver oxide, 429 

Zinc oxide, 422 
Gastric Cancer — 

Arsenic, 395 

Pepsin, 498 
Gastric Catarrh — 

Bitters, 497 

Strychnine, 231 
Gastric Dilatation — 

Physostigma, 578 
Gastric Fermentation — 

Hyposulphites, 283 

Potassium permanganate, 279 



Gastric Hemorrhage — 

Alum, 433 

Suprarenal extract, 256 
Gastric Pain — 

Bismuth subnitrate, 436 

Cantharidal blister, 321 
Gastric Ulcer — 

Arsenic, 395 

Bismuth subnitrate, 436 

Lead acetate, 419 

Manganese dioxide, 413 

Pepsin. 498 

Potassium dichromate, 490 

Resorcin, 295 

Silver nitrate, 429 

Silver oxide, 429 
Gastritis — 

Acacia, 600 

Bismuth subnitrate, 436 

Demulcents, 595 

Lead acetate, 419 

Resorcin, 295 

Silver nitrate, 429 
Genito -urinary Diseases — 

Opium, 185 

Terebene, 328 

Thymol, 341 
Genito -urinary Tract, Irritation of— 

Manna, 524 
Gingivitis — 

Borax, 489 

Boric acid, 489 

Hydronaphthol, 298 
Glandular Swellings — 

Solution of ammonium acetate, 573 

Tincture of iodine, 470 
Glaucoma — 

Eserine, 577 
Gleet- 
Alum, 432 

Buchu, 347 

Copaiba, 350 

Copper sulphate, 425 

Geranium, 448 

Krameria, 445 

Lead acetate, 418 

Tar water, 358 

Tincture of cantharides, 321 

Turpentine, 327 
Glossitis — 

Chromic acid, 590 
Goiter — 

Red iodide of mercury ointment, 402 

Tincture of iodine, 470 
Goiter, Exophthalmic — 

Belladonna, 207 

Bromides, 198 

Digitalis, 241 
Ergot, 252 
Gonorrhea — 
Acetic acid, 485 
Alum, 432 
Alumnol, 297 
Bismuth subnitrate, 436 






CLINICAL INDEX. 



677 



Gonorrhea — 

Bismuth tannate, 437 

Borax, 489 

Boric acid, 489 

Buchu, 347 

Cannabis, 193 

Chromic acid, 591 

Copaiba, 350 

Copper sulphate, 425 

Geranium, 448 

Glycerin, 597 

Hamamelis, 447 

Hexamethylenamine, 568 

Hydrastis, 234 

Hydrogen dioxide, 278 

Kino, 444 

Lead acetate, 418 

Oil of sandalwood, 351 

Potassium permanganate, 279 

Quinine bisulphate, 371 

Resorcin, 295 

Salol, 312 

Silver nitrate, 429 

Sodium phenolsulphonate, 302 

Tannic acid, 440 

Turpentine, 327 

Zinc acetate, 422 

Zinc chloride, 593 

Zinc iodide, 423 

Zinc sulphate, 423 
Gonorrheal Rheumatism — 

Salicylic acid, 311 
Gout- 
Alkalies, 461 

Colchicum, 580 

Guaiac, 583 

Lactic acid, 483 

Lithium salicylate, 311 

Potassium iodide, 471 

Salicylic acid, 311 

Sulphurous baths, 526 

Tincture of iodine, 470 
Gouty Diathesis — 

Sodium salts, 541 
Gouty Dyspepsia — 

Manganese sulphate, 414 
Gouty Joints — 

Piperazin, 568 
Granular Lids — 

Bismuth subnitrate, 436 
Granulations — 

Alum, 432 
Griping — 

Hyoscyamus, 209 
Gummata — 

Iodides, 471 
Gums, Inflamed — 

Hamamelis, 447 
Gums, Overriding — 

Alum, 432 
Gums, Spongy — 

Krameria, 445 

Rhus glabra, 448 

Tannic acid, 440 



Gums, Swollen — 

Alum, 432 
Gums, Ulcerous — 

Tannic acid, 440 



Habitual Constipation — 

Strychnine, 231 
Hay Fever — 

Ammonium iodide, 471 

Arsenic, 395 

Grindelia, 354 

Quinine, 371, 372 

Resorcin, 295 
Headache — 

Acetanilid, 379 

Aromatic spirit of ammonia, 274 

Arsenic, 394 

Bromides, 198 

Caffeine, 259 

Cannabis, 193 

Ergot, 252 

Menthol, 339 

Quinine, 372 

Salicylic acid, 311 

Spirit of nitrous ether, 574 

Valerian, 363 
Heart, Dilatation of — 

Digitalis. 240 

Ergot, 252 
Heart Failure — 

Ammonium preparations, 274 

Strophanthin, 244 
Heart, Fatty Degeneration of — 

Iodides, 471 
Heart, Functional Irregularity of- 

Adonidin, 248 

Strychnine, 231 
Heart, Irritable — 

Strophanthin, 244 
Heart, Palpitation of — 

Aconite, 262 

Ether, 156 
Heart, Tobacco — 

Strophanthin, 244 
Heart, Valvular Diseases of — 

Casca bark, 248 

Diuretin, 566 

Iodides, 471 
Hematemesis — 

Ipecac, 514 
Hematuria — 

Alum, 433 
Hemoptysis — 

Acetanilid, 378 

Fluidextract of hydrastis, 234 

Ipecac, 514 

Lead acetate, 419 
Hemorrhage — 

Alcohol, 151 

Alum, 432, 433 

Ergot, 252 

Hamamelis, 447 

Iron, 411 



678 



CLINICAL INDEX. 



Hemorrhage — 

Lead acetate, 418 

Opium, 187 

Pyrogallol, 442 

Senegin, 558 
Hemorrhage From Bladder — 

Hamamelis, 447 
Hemorrhage, Gastric — 

Alum, 433 

Suprarenal extract, 256 
Hemorrhage, Intestinal — 

Alum, 433 

Opium, 188 

Tannic acid, 440 

Turpentine, 326 
Hemorrhage of Menopause — 

Hydrastine, 234 
Hemorrhage of Puberty — 

Hydrastine, 234 
Hemorrhage, Postpartum — 

Digitalis, 242 

Ergot, 252 

Ether, 156 

Sodiobenzoate of caffeine, 259 

Strychnine, 232 
Hemorrhage, Uterine — 

Alcohol, 150 

Ergot, 252 

Hydrastine, 234 

Ipecac, 514 

Krameria, 445 

Nitric acid, 480 

White oak, 443 
Hemorrhoids — 

Belladonna ointment, 206 

Chromic acid, 591 

Cocaine, 216 

Ergotin, 252 

Galla, 442 

Gallic acid, 441 

Hamamelis, 447 

Iodoform, 288 

Krameria, 445 

Lead acetate, 418 

Manna, 524 

Menthol, 339 

Nitric acid, 480 

Potassium bromide, 198 

Rhubarb, 530 

Sulphur, 526 

Tannic acid, 440 

White oak, 443 
Hepatic Colic — 

Belladonna, 207 
Hepatic Congestion — 

Calomel, 402 

Gamboge, 535 
Hepatic Diseases — 

Colocynth, 536 

Nitrohydrochloric acid, 481 
Hepatic Dyspepsia — 

Ipecac, 513 
Hepatitis — 

Calomel, 402 



Hernia, Scrotal — 

White oak, 443 
Herpes — 

Aconite, 262 

Bismuth subgallate, 436 

Hamamelis, 447 

Lycopodium, 603 

Nutgall ointment, 442 

Potassium chlorate, 492 

Salicylic acid, 311 

Tannic acid, 440 

Thiol, 304 
Hiccough — 

Chloral, 174 

Coffee, 259 

Ether, 156 

Infusion of mustard, 323 

Nitroglycerin, 271 

Pilocarpine, 571 
Hoarseness — 

Borax, 489 

Boric acid, 489 

Compound tincture of benzoin, 307 

Cubeb, 353 

Liquorice, 556 

Potassium dichromate, 490 
Hodgkin's Disease — 

Arsenic, 394 
Horny Growths — 

Glacial acetic acid, 485 

Trichloracetic acid, 485 
Hospital Gangrene — 

Nitric acid, 480 
Hydrocele — 

Chloral, 173 

Tincture of iodine, 470 
Hydrocyanic Acid, Poisoning From- 

Ammonia, 274 
Hydrophobia — 

Opium, 186 
Hydrothorax — 

Flying blisters, 320 
Hyperemia, Cerebral — 

Belladonna, 207 

Ergot, 252 
Hyperemia, Pulmonary — 

Oil of turpentine, 326 
Hyperemia, Spinal — 

Belladonna, 207 
Hyperpyrexia, Rheumatic — 

Salicylic acid, 311 
Hypertrophy, Cardiac — 

Aconite, 262 
Hypertrophy, Nasal — 

Ergotin, 252 
Hypochondriasis — 

Valerian, 363 
Hysteria — 

Asafetida, 362 

Chloral, 174 

Compound spirit of ether, 156 

Oil of rue, 550 

Sumbul, 585 

Tansy, 551 



CLINICAL INDEX. 



679 



Hysteria — 

Valerian, 363 
Hysterical Convulsions — 

Hyoscyamus, 209 



Ileo-colitis — 

Calomel, 402 
Impetigo — 

Hyposulphites, 283 

Lead acetate, 418 

Quinine, 372 

Salicylic acid, 310 

Sulphur, 525 

Tannic acid, 440 
Impotence — 

Alcohol, 152 

Blood-root, 560 

Cannabis, 193 

Tincture of cantharides, 321 
Incontinence of Urine — 

Ammonium benzoate, 307 

Belladonna, 206 

Buchu, 347 

Ergot, 252 

Hyoscyamus, 209 

Tincture of cantharides, 321 
Indigestion — 

Bromides, 198 

Hydrochloric acid, 481 

Mustard, 323 
Indolent Ulcers — 

Fluidextract of hydrastis, 234 
Indurated Tonsils — 

Zinc iodide, 423 
Infantile Convulsions — 

Asafetida, 362 

Bromides, 198 
Inflammation- 
Capsicum, 342 

Lead acetate, 418 

Linseed oil, 599 

Liquor plumbi subacetatis, 419 

Menthol, 339 

Oil of turpentine, 326 

Opium, 184 

Potassium nitrate, 464 

Tartar emetic, 511 
Inflammation of Cartilaginous Struc- 
tures — 

Potassium iodide, 471 
Inflammation of Eye — 

Red rose 449 

Suprarenal extract, 255 
Inflammation of Fauces — 

Silver nitrate, 429 
Inflammation of Female Genital 
Organs — 

Ichthyol, 304 
Inflammation of Gums — 

Hamamelis, 447 
Inflammation of Mouth — 

Tincture of arnica. 268 



Inflammation of Nose — 

Carbolic acid, 292 
Inflammation of Throat — 

Carbolic acid, 292 
Inflammatory Conditions About Ar- 
ticulations — 

Belladonna ointment, 206 
Influenza — 

Acetanilid, 378 

Iron, 411 

Salicylic acid, 311 

Solution of ammonium acetate, 573 
Ingrowing Toenail — 

Alum, 433 

Liquor potassae, 460 
Inguinal Glands, Adenitis of — 

Pilocarpine, 572 
Insanity — 

Sulphonal, 168 
Insects, Bites of — 

Olive oil, 598 
Insect -stings — 

Olive oil, 598 

Rhus toxicodendron, 330 
Insomnia — 

Bromides, 198 

Chloral, 173 

Chloral formamide, 175 

Compound spirit of ether, 156 

Lactucarium, 191 

Opium, 186 
Intermittent Fever — 

Antipyrine, 375 

Casca bark, 248 

Quinine, 372 

Resorcin, 295 
Intertrigo — 

Bismuth subnitrate, 436 

Lycopodium, 603 

Tannic acid, 440 

Zinc carbonate, 423 

Zinc oxide, 422 
Intestinal Catarrh — 

Copaiba, 351 

Salol, 313 

Turpentine, 326 
Intestinal Colic — 

Belladonna, 207 
Intestinal Dilatation — 

Physostigma, 578 
Intestinal Fermentation — 

Oxgall, 529 

Sulphurous acid, 282 
Intestinal Hemorrhage — 

Alum, 433 

Opium, 188 

Tannic acid, 440 

Turpentine, 326 
Intestinal Indigestion — 

Hydrochloric acid, 481 
Intestinal Obstruction — 

Croton oil, 534 
Intestinal Paresis — 

Physostigma, 578 



68o 



CLINICAL INDEX. 



Intestinal Ulceration — 

Silver nitrate, 429 
Iridochoroiditis — 

Salicylic acid, 311 
Iris, Prolapse of — 

Physostigmine, 577 
Iritis — 

Calomel, 402 
Irritability, Cardiac — 

Bromides, 198 
Irritability, Nervous — 

Bromides, 198 
Irritable Heart — 

Strophanthin, 244 
Irritation of Genito -urinary Tract- 
Manna, 524 
Irritation of Throat — 

Cannabis, 193 
Irritation, to Prevent — 

Lycopodium, 603 
Itching — 

Glycerin, 597 



Jaborandi Poisoning — 

Atropine, 207 

Jaundice — 
Aloes. 528 
Citric acid, 485 
Manganese sulphate, 413 
Oxgall, 529 
Pilocarpine, 572 
Quinine, 372 

Jaundice, Catarrhal — 
Salol, 313 

Joint -affections- 
Ammonium liniment, 274 

Joint -cavities- 
Hydrogen dioxide, 278 

Joints, Gouty — 
Piperazin, 568 

Joints, Thickening About — 
Vesicants, 318 



Keratitis — 
Gallicine, 442 

Yellow oxide of mercury, 401 
Kidneys, Congestion of— 

Spirit of nitrous ether, 574 



Labor Pains — 

Chloral, 174 
Laryngeal Croup — 

Silver nitrate, 429 
Laryngeal Papillomata- 

Chromic acid, 590 
Laryngismus Stridulus- 

Belladonna, 206 

Bromides, 198 

Chloral, 174 
Laryngitis — 
A< acia, 600 



Laryngitis — 

Aconite, 262 

Alum, 433 

Ammonium chloride, 555 

Antipyrine, 375 

Camphor, 362 

Carbolic acid, 292 

Chromic acid, 590 

Compound syrup of squills, 511 

Glycerin, 597 

Iodine, 471 

Ipecac, 513 

Resorcin, 295 

Salol, 312 

Senega, 558 

Tartar emetic, 511 
Larynx, Congestion of — 

Creosote, 300 
Larynx, Relaxed Conditions of— 

Iron, 411 
Larynx, Ulceration of — 

Silver nitrate, 429 
Lead Colic — 

Alum, 433 

Belladonna, 206 

Croton oil, 534 
Lead-poisoning — 

Alum, 433 

Croton oil, 534 

Magnesium sulphate, 541 

Sulphuric acid, 481 
Leg, Ulceration of — 

Iodoform, 288 
Lentigo— 

Tincture of iodine, 470 
Lepra — 

Arsenic, 394 
Leucorrhea — 

Alum, 432 

Bismuth subnitrate, 436 

Bismuth tannate, 437 

Borax, 489 

Boric acid, 489 

Chromic acid, 591 

Ergot, 252 

Fluidextract of hydrastis, 234 

Geranium, 448 

Glycerite of tannic acid, 597 

Haematoxylon, 446 

Kino, 444 

Krameria, 445 

Lead acetate, 418 

Lime water, 461 

Myrrh, 335 

Potassium permanganate, 279 

Rhus glabra, 448 

Silver nitrate, 428 

Tannic acid, 440 

Tar water, 358 

White oak, 443 

Zinc acetate, 422 

Zinc chloride, 593 

Zinc oxide, 422 

Zinc sulphate, 423 



CLINICAL INDEX. 



681 



481 



Leukemia — 

Arsenic, 394 
Lichen — 

Lead acetate, 418 
Suphuric acid, 482 
Lichen Ruber — 

Arsenic, 394 
Lips, Chapped — 

Ointment of rose, 449 
Lithemia — 

Buchu, 347 

Lactic acid, 483 

Nitric acid, 481 

Nitrohydrochloric acid, 
Lithiasis — 

Potassium permanganate, 279 
Liver, Torpor of — 

Podophyllum, 538 
Locomotor Ataxia — 

Acetanilid, 379 

Nitroglycerin, 271 

Silver nitrate, 429 
Lumbago — 

Acetanilid, 379 

Belladonna, 206 

Capsicum, 342 

Guaiac, 583 

Oil of turpentine, 326 

Salicylic acid, 311 
Lungs, Congestion of — 

Digitalis, 241 

Elaterin, 535 

Ergot, 252 
Lungs, Gangrene of — 

Carbolic acid, 292 

Eucalyptus, 336 

Salicylic acid, 310 

Sodium hyposulphite, 283 
Lungs, Inflammation of — 

Gelsemium, 225 
Lupus — 

Carbolic acid, 292 

Copaiba, 350 

Pyrogallol, 442 

Salicylic acid, 310 

Tincture of iodine, 470 

Zinc chloride, 593 
Lupus Erythematosus — 

Hamamelis, 447 

Ichthyol, 304 
Lymphadenoma — 

Phosphorus, 386 
Lymphangitis — 

Colloidal silver, 430 
Lymphatic Enlargement — 

Ichthyol, 304 

Plumbi iodide, 419 

Potassium iodide, 471 
Lymphoma — 

Arsenic, 394 



Malaria — 

Amyl nitrite, 271 



Malaria — 

Antipyrine, 375 
Arsenic, 394 
Carbolic acid, 293 
Citric acid, 485 
Nuclein, 607 
Quinine, 371 
Malarial Fever — 
Bitters, 497 
Quinine, 371 
Malarial Jaundice — 

Manganese sulphate, 413 
Mammary Engorgements — 
Olive oil, 598 

Solution of ammonium acetate, 573 
Mania — 

Cannabis, 193 
Digitalis, 241 
Ergot, 252 
Gelsemium, 224 
Mania, Puerperal — 

Chloral, 173 
Mania a Potu — 
Acetanilid, 379 
Mastitis — 

Ammonium chloride, 555 
Phytolacca, 266 
Measles — 
Iron, 411 

Mustard bath, 323 
Melancholia — 
Cannabis, 193 
Meningitis — 
Blisters, 318 
Calomel, 402 
Digitalis, 241 
Iodides, 471 
Meningitis, Cerebrospinal — 
Aconite, 263 
Alcohol, 151 
Ergot, 252 
Gelsemium, 225 
Meningocele, Spinal — 

Tincture of iodine, 470 
Menopause, Hemorrhage of — 

Hydrastine, 234 
Menopause, Reflex Disturbances of— 

Bromides, 198 
Menopause, Vasomotor Disturb- 
ances of — 
Valerian, 363 
Menorrhagia — 
Aloes, 528 
Alum, 433 
Belladonna, 207 
Black haw, 584 
Bromides, 198 
Ergot, 252 
Oil of savine, 550 

Solution of ammonium acetate, 573 
Tincture of cantha rides, 321 
Menses, to Restore or Increase — 
Mustard sitz-bath, 323 
Tansy, 551 



682 



CLINICAL INDEX. 



Menstrual Disorders — 

Iron, 411 
Menstruation, Retarded or Sus- 
pended — 

Hedeoma, 552 
Mercurial Cachexia — 

Iodine, 471 
Mercurial Ptyalism — 

Alum, 432 

Belladonna, 206 
Mercurial Salivation — 

Bismuth subnitrate, 436 
Mercurial Sore Mouth — 

Copper sulphate, 425 

Silver nitrate, 429 
Metritis — 

Ergot, 252 

Tincture of iodine, 470 
Metrorrhagia — 

Geranium, 448 
Migraine — 

Caffeine, 259 

Cannabis, 193 

Rochelle salt, 541 

Seidlitz powder, 541 

Solution of ammonium acetats, 573 

Solution of magnesium citrate, 541 
Milk, Secretion of, Checking — 

Belladonna, 206 
Mitral Insufficiency — 

Adonidin, 248 
Mitral Regurgitation — 

Digitalis, 240 
Moles — 

Nitric acid, 480 
Morbid Growths — 

Zinc Chloride, 593 
Morphine-poisoning — 

Atropine, 207 

Potassium permanganate, 280 

Strychnine, 232 
Mouth, Diseases of — 

Castor oil, 521 

Potassium citrate, 461 

Potassium tartrate, 461 
Mouth, Dryness of — 

Glycerin, 597 
Mouth, Inflammation of — 

Tincture of arnica, 268 
Mouth, Ulceration of — 

Chromic acid, 590 
Mucous Catarrhs — 

Potassium iodide, 471 
Mucous Patches — 

Potassium chlorate, 492 

Potassium dichromate, 490 
Mumps — 

Pilocarpine, 572 
Muscular Pains — 

Tansy, 5^1 
Muscular Rheumatism — 

Guaiac, 583 

Potassium iodide, 471 

Solution of ammonium acetate, 573 



Myalgia — 

Oil of turpentine, 326 

Salol, 313 
Mydriasis — 

Eserine, 577 
Myelitis — 

Ergot, 252 
Myocarditis — 

Caffeine, 258 

Diuretin, 566 
Myoclonus — 

Chloral, 174 
Myxedema — 

Thyroid extract, 605 



Narcotic-poisoning — 

Alcohol, 151 

Mustard, 323 

Rubefacients, 587 
Nasal Catarrh — 

Bismuth oxide, 436 

Bismuth subnitrate, 436 

Borax, 489 

Boric acid, 489 

Glycerin, 597 

Sodium bicarbonate, 461 

Sodium phenolsulphonate, 302 
Nasal Hypertrophies — 

Ergotin, 252 
Nasal Polypi — 

Chromic acid, 590 

Zinc sulphate, 423 
Nausea — 

Ether, 156 

Menthol, 339 

Opium, 188 

Spirit of nitrous ether, 574 
Neoplasms — 

Cocaine, 216 
Nephritis — 

Amyl nitrite, 271 

Diuretin, 566 

Elaterin, 535 

Mercury, 402 

Opium, 188 

Potassium Bitartrate, 462 

Scoparius, 226 
Nervous Debility — 

Rubefacients, 587 
Nervous Disorders — 

Cod-liver oil, 504 
Nervous Exhaustion — 

Phosphorus, 386 
Nervous Irritability — 

Bromides, 198 
Nervous System, Diseases of— 

Croton oil, 534 
Nervousness — 

Lactucarium, 191 

Spirit of nitrous ether, 574 
Neuralgia — 

Acetanilid, 379 

Aconite, 262 



CLINICAL INDEX. 



683 



Neuralgia — 

Arsenic, 394 
Belladonna, 206 
Belladonna plaster, 306 
Blisters, 318 
Camphor chloral, 362 
Camphorated chloral, 173 
Cannabis, 193 
Cantharidal plaster, 321 
Capsicum, 342 
Chloral, 174 
Colchicum, 580 
Ether, 156 
Hyoscyamus, 209 
Iron, 411 
Oil of cloves, 345 
Oil of turpentine, 326 
Opium, 187 
Phosphorus, 386 
Quinine, 372 
Strychnine, 231 
Veratrine ointment, 264 
Neuralgia of Eyeball — 

Eserine, 577 
Neuralgia, Ovarian — 
Gelsemium, 225 
Sumbul, 585 
Neuralgic Pains — 
Rubefacients, 587 
Neurasthenia — 
Iron, 411 

Phosphoric acid, 481 
Phosphorus, 386 
Sumbul, 585 
Neuritides — 

Strychnine, 231 
Neuritis — 

Acetanilid, 379 
Salol, 313 

Tincture of iodine, 470 
Neurotic Asthma — 

Strychnine, 231 
Nevi — 

Nitric acid, 480 
Zinc chloride, 593 
Night-blindness — 

Strychnine, 231 
Night -sweats — 
Belladonna, 206 
Camphoric acid, 363 
Fluidextract of hydrastis, 234 
Lead acetate, 419 
Strychnine, 232 
Nipples, Chapped — 

White oak, 443 
Nipples, Cracked — 

Chloral, 173 
Nipples, Sore — 
Silver nitrate, 429 
Tannic acid, 440 
Nocturnal Emissions— 

Digitalis, 242 
Noma — 

Hydrochloric acid, 480 



Nose, Diseases of — 

Ammonium chloride, 555 

Aristol, 289 

Cubeb, 353 

Hydrogen dioxide, 278 

Ichthyol, 304 

Iodoform, 288 

Mercury, 401 

Nitric acid, 480 

Oil of peppermint, 339 

Opium, 185 

Potassium chlorate, 492 

Sulphur, 525 

Tar, 358 

Thymol, 341 
Nose, Inflammation of — 

Carbolic acid, 292 
Noxious Gases, Poisoning From — 

Ammonia, 274 
Nymphomania — 

Bromides, 198 
Nystagmus — 

Physostigmine sulphate, 577 

Obesity — 

Phytolacca, 266 
Offensive Discharges — 

Plumbi nitras, 419 
Offensive Expectoration — 

Salicylic acid, 310 
Onychia — 

Plumbi nitras, 419 

Tincture of iodine, 470 
Ophthalmia — 

Alum, 432 

Bismuth tannate, 437 

Potassium permanganate, 279 

Silver nitrate, 428 

Yellow oxide of mercury, 401 

Zinc sulphate, 423 
Opium Habit — 

Cocaine, 217 

Iron, 411 

Scoparius, 226 
Opium Poisoning — 

Caffeine, 259 
Orchitis — 

Ammonium chloride, 555 

Belladonna ointment, 206 

Lead acetate, 418 

Mercurial ointment, 401 
Os Uteri, Rigidity of — 

Chloral, 174 

Ipecac, 514 
Os Uteri, Venereal Ulcerations of- 

Solution of nitrate of mercury, 402 
Osteitis — 

Hydrochloric acid, 480 
Osteomalacia — 

Phosphorus, 386 
Otitis— 

Antipyrine, 375 

Cod-liver oil, 504 



68 4 



CLINICAL INDEX. 



Otitis— 

Suprarenal extract, 255 

Zinc sulphate, 423 
Otitis Media- 
Bismuth subgallate, 436 

Cantharidal blister, 321 
Otorrhea — 

Borax, 489 

Carbolic acid, 292 

Lead acetate, 418 

Salicylic acid, 310 

Silver nitrate, 429 

Tannic acid, 440 
Ovarian Neuralgia — 

Gelsemium, 225 

Sumbul, 585 
Ovarian Pain — 

Opium, 188 
Ovaritis — 

Cantharidal blister, 321 
Overriding Gums — 

Alum, 432 
Oxaluria — 

Lactic acid, 483 

Nitric acid, 481 

Nitrohydrochloric acid, 481 
Oxyuris — 

Santonin, 544 
Oxyuris Vermicularis — 

Quassia, 497 
Ozena — 

Bismuth oxide, 436 

Bismuth subnitrate, 436 

Camphor, 362 

Camphorated naphthol, 298 

Chromic acid, 590 

Cod-liver oil, 504 

Krameria, 445 

Myrrh, 335 

Potassium permanganate, 279 

Quinine, 371 

Saccharin, 586 

Salol, 312 

Solution of chlorinated soda, 285 

Tannic acid, 440 



Pachymeningitis — 

Red iodide of mercury ointment, 402 
Pain — 

Belladonna, 207 

Chamomile, 497 

Conium, 221 

Ether, 156 

Opium, 185, 188 
Pain, Gastric — 

Bismuth subnitrate, 436 

Cantharidal blister, 321 
Painful Conditions From Deficient 
Secretion of Gastric Juice — 

Ammonium preparations, 461 
Palpitation of Heart — 

A< onite, 262 



Palpitation of Heart — 

Ether, 156 
Pannus — 

Yellow oxide of mercury, 401 
Papilloma, Laryngeal — 

Chromic acid, 590 
Paralysis — 

Blisters, 318 

Iodides, 471 

Sulphurous acid, 282 
Paralysis Agitans — 

Cocaine, 217 

Gelsemium, 224 

Hyoscyamus, 209 

Parathyroid gland, 606 
Paralysis of Accommodation — 

Eserin, 577 
Parasitic Skin Diseases — 

Acetic acid, 485 

Chlorine water, 284 

Naphthalene, 297 

Salicylic acid, 310 

Sulphurous acid, 282 
Paresis, Intestinal — 

Physostigma, 578 
Paresis of Ocular Muscles — 

Strychnine, 231 
Paronychia — 

Lead acetate, 418 
Pelvic Cellulitis— 

Mercurial ointment, 401 
Pelvic Pain — 

Opium, 188 
Pemphigus — 

Arsenic, 394 
Perforation of Tympanic Membrane- 
Carbolic acid, 292 
Pericarditis — 

Aconite, 262 

Blisters, 318 

Calomel, 402 

Cantharidal blister, 320 

Diuretin, 566 

Iodides, 471 
Pericarditis With Effusion — 

Squill, 247 
Periostitis— 

Cantharidal blister, 321 

Iodides, 471 

Tincture of iodine, 470 
Peritonitis — 

Aconite, 262 

Opium, 187 

Turpentine stupe, 326 
Pernicious Anemia — 

Arsenic, 394 

Phosphorus, 386 
Phagedenic Sores — 

Potassium chlorate, 492 
Phagedenic Ulceration — 

Nitric acid, 480 

Solution of nitrate of mercury, 402 
Pharyngeal Cough — 

Liquorice, 556 



CLINICAL INDEX. 



685 



Pharyngeal Mucous Membrane, Re- 
laxation of — 

Alum, 432 
Pharyngitis — 

Acacia, 600 

Aconite, 262 

Alcohol, 150 

Alum, 432 

Ammonium chloride, 555 

Antipyrine, 375 

Aromatic spirit of ammonia, 274 

Balsam of tolu, 356 

Borax, 489 

Boric acid, 489 

Bromides, 197 

Calendula, 497 

Camphoric acid, 363 

Capsicum, 342 

Ergot, 252 

Gallic acid, 441 

Glycerin, 597 

Guaiac, 583 

Hamamelis, 44', 

Hedeoma, 552 

Iron, tincture of chloride of, 411 

Kino, 444 

Krameria, 445 

Mezereum, 589 

Myrrh, 335 

Phytolacca, 266 

Potassium chlorate, 492 

Potassium dichromate, 490 

Potassium nitrate, 464 

Resorcin, 295 

Rhus glabra, 448 

Silver nitrate, 429 

Sodium benzoate, 308 

Solution of ammonium acetate, 573 

Sulphur, 525 

Sulphurous acid, 282 

Tannic acid, 440 

Tincture of iodine, 471 
Pharynx, Gangrene of — 

Copper sulphate, 425 
Pharynx, Relaxed Conditions of — 

Iron, 411 
Phimosis — 

Cocaine, 216 
Phlegmasia Dolens — 

Hamamelis, 447 
Phlyctenular Ophthalmia — 

Yellow oxide of mercury, 401 
Phosphorus-poisoning — 

Copper sulphate, 425 

Magnesium carbonate, 523 
Photophobia — 

Eserine, 577 
Phthiriasis — 

Pilocarpine, 572 
Phthisis — 

Acetanilid, 378 

Balsam of Peru, 355 

Belladonna, 206 

Benzoic acid, 307 



Phthisis- 
Camphoric acid, 363 
Cannabis, 193 
Cerium oxalate, 438 
Creosote, 299, '300 
Fluidextract of hydrastis, 234 
Guaiacol, 301 
Hydronaphthol, 298 
Iodine, 471 
Ipecac, 514 
Lead acetate, 419 
Lime water, 462 
Pilocarpine, 572 
Quinine, 372 
Salicylic acid, 310 
Strychnine, 232 
Sulphuric acid, 481 
Sulphurous acid, 282 
Tar, 358 
Terebene, 328 
Thymol, 341 
Wild cherry, 497 
Physostigma-poisoning — 
Atropine, 207 
Strychnine, 232 
Pityriasis — 

Acetic acid, 485 

Aromatic spirit of ammonia, 274, 461 
Pityriasis Capitis — 

Resorcin, 295 
Pleurisy — 
Aconite, 262 
Blisters, 318 
Cantharidal blister, 320 
Flying blisters, 320 

Gelsemium, 225 
Iodides, 471 

Oil of turpentine, 326 

Opium, 186 

Quinine, 372 

Salicylic acid, 311 

Squill, 247 

Tincture of iodine, 470 
Pleuritic Effusions — 

Caffeine, 258 

Digitalis, 242 

Diuretin, 566 

Pilocarpine, 571 

Salines, 541 
Pleurodynia — 

Belladonna, 206 
Pneumonia — 

Acetanilid, 378 

Aconite, 262 

Ammonium carbonate, 274 

Ammonium iodide, 471 

Apomorphine, 508 

Arsenic, 395 

Calomel, 402 

Cantharidal blister, 320 

Digitalis, 241 

Grindelia, 354 

Iodides, 471 

Ipecac, 514 



686 



CLINICAL INDEX. 



Pneumonia — 

Potassium nitrate, 464 

Quinine, 372 

Serpentaria, 497 

Serum-therapy, 611 

Strychnine, 231 

Tartar emetic, 511 
Pneumothorax — 

Carbolic acid, 292 
Poisoning — 

Magnesia, 523 

Magnesium carbonate, 523 

Olive oil, 599 
Poisoning by Venomous Reptiles- 
Alcohol, 151 

Calmette's serum, 613 
Polypi — 

Chromic acid, 590 

Hamamelis, 447 

Zinc chloride, 593 
Polypi, Nasal — 

Zinc sulphate, 423 
Polypi, Uterine — 

Ergot, 252 
Portal Congestion — 

Colchicum, 581 
Postpartum Hemorrhage — 

Digitalis, 242 

Ergot, 252 

Ether, 156 

Sodiobenzoate of caffeine, 259 

Strychnine, 232 
Pregnancy, Constipation of — 

Senna, 533 
Pregnancy, Vomiting of — 

Ammonium bromide, 198 

Chloral, 174 

Tincture of iodine, 472 
Prepuce, Edema of — 

Glycerin, 597 
Prickly Heat- 
Citric acid, 485 
Proctitis — 

Copaiba, 351 
Prolapse of Iris — 

Physostigmine, 577 
Prolapse of Rectum — 

Ergotin, 252 

Nitric acid, 480 

Nutgall ointment, 442 
Prolapsus ani — 

Bismuth subnitrate, 436 

Geranium, 448 

Krameria, 445 

Tannic acid, 440 

White oak, 443 
Prostate Gland, Enlargement of — 

Ergotin, 252 
Prostatitis — 

Belladonna, 207 

Hyoscyamus, 209 
Prostatorrhea — 

Tincture of rantharides, 321 

Turpentine, 327 



Prurigo — 

Arsenic, 394 

Ergot, 252 

Sulphuric acid, 482 
Pruritus — 

Aconite, 262 

Alum, 432 

Camphorated chloral, 173 

Cannabis, 193 

Carbolic acid, 292 

Ether, 156 

Gallanol, 442 

Gelsemium, 225 

Liquor plumbi subacetatis, 419 

Menthol, 339 

Nitric acid, 480 

Pilocarpine, 572 

Piperazin, 568 

Salicylic acid, 310 

Silver nitrate, 429 

Tar, 357 

Zinc sulphate, 422 
Pruritus Vulvae — 

Balsam of Peru, 355 

Silver nitrate, 429 
Pseudo -angina — 

Nitroglycerin, 271 
Psoriasis — 

Ammonium carbonate, 274, 461 

Arsenic, 394 

Copaiba, 350, 351 

Eucalyptus, 336 

Gallanol, 442 

Pilocarpine, 572 

Plumbi iodide, 419 

Pyrogallol, 442 

Resorcin, 295 

Salicylic acid, 310 

Strophanthus, 244 

Sulphur, 525 

Tar, 357 

Turpentine, 326 
Ptyalism — 

Krameria, 445 

Myrrh, 335 

Pilocarpine, 572 

Potassium chlorate, 492 

Rhus glabra, 448 
Ptyalism, Mercurial — 

Alum, 432 

Belladonna, 206 
Puerperal Eclampsia — 

Amyl nitrite, 271 

Chloral, 174 

Veratrum viridc, 265 
Puerperal Fever — 

Colloidal silver, 430 

Iron, 411 

Quinine, 372 

Serum-therapy, 612 

Tercbene, 328 
Puerperal Mania — 

Chloral, 173 



CLINICAL INDEX. 



687 



Puerperal Septic Endometritis — 

Hydrogen dioxide, 278 
Puerperal Septicemia — 

Opium, 187 
Pulmonary Affections — 

Nuclein, 607 
Pulmonary Hyperemia — 

Oil of turpentine, 326 
Pulp of Decayed Teeth, to Destroy- 

Zinc chloride, 593 
Purpura — 

Ergot, 252 

Sulphuric acid, 482 
Purpura Haemorrhagica — 

Digitalis, 242 
Pyelitis — 

Benzoic acid, 307 

Buchu, 347 

Copaiba, 350 

Tincture of cantharides, 321 
Pyemia — 

Alcohol, 152 

Quinine, 372 
Pyonephrosis — 

Turpentine, 327 
Pyorrhea Alveolaris — 

Tincture of iodine, 470 

Betanaphthol, 298 
Pyrosis- 
Bismuth subnitrate, 436 

Manganese dioxide, 413 



Quinsy — 

Aconite, 262 
Guaiac, 583 
Salicylic acid, 311 



Rabid Animals, Bites of — 

Sulphuric acid, 480 
Rabies — 

Serum -therapy, 614 
Rachitis — 

Cod-liver oil, 504 

Phosphorus, 386 
Rectal Bleeding — 

Krameria, 445 
Rectal Fissures, — 

Hamamelis, 447 
Rectal Prolapse — 

Nutgall ointment, 442 
Rectal Ulcers — 

Fluidextract of hydrastis, 234 

Potassium chlorate, 492 

Tannic acid, 440 
Rectum, Diseases of — 

Cocaine, 216 

Opium, 188 
Rectum, Prolapse of — 

Ergotin, 252 

Nitric acid, 480 
Rectum, Relaxed — 

Geranium, 448 



Rectum, Ulceration of — 

Silver nitrate, 429 
Relaxation of Pharyngeal Mucous 
Membrane — 

Alum, 432 
Relaxed Rectum — 

Geranium, 448 
Relaxed Sore Throat — 

Copper sulphate, 425 

Zinc sulphate, 423 
Relaxed Throat- 
Geranium, 448 

Myrrh, 335 
Relaxed Uvulva — 

Alum, 432 

Capsicum, 342 

Kino, 444 

Krameria, 445 

White oak, 443 
Relaxed Vagina — 

Geranium, 448 
Renal Calculi — 

Diuretics, 564 

Opium, 187 
Renal Colic — 

Belladonna, 207 
Renal Diseases — 

Colocynth, 536 
Renal Dropsy — 

Caffeine, 258 

Casca bark, 248 

Digitalis, 242 
Reptiles, Venomous, Poisoning by — 

Alcohol, 151 

Ammonia, 274 

Serum-therapy, 613 
Respiratory Organs, Inflamed Con- 
ditions of — 

Althaea, 601 
Respiratory Passages, Diseases of — 

Cubeb, 353 
Restlessness — 

Compound spirit of ether, 156 
Rheumatic Arthritis — 

Salicylic acid, 311 
Rheumatic Hyperpyrexia— 

Salicylic acid, 311 
Rheumatic Pains — 

Capsicum, 342 
Rheumatism — 

Acetanilid, 378 

Aconite, 262 

Alcohol, 150 

Alkalies, 462 

Ammonium liniment, 274 

Arnica, 267 

Arsenic, 395 

Asaprol, 298 

Belladonna plaster, 206 

Betol, 298 

Buchu, 347 

Camphoric acid, 363 

Citric acid, 485 

Cod-liver oil, 504 



688 



CLINICAL INDEX. 



Rheumatism — 

Colchicum, 580 

Guaiac, 583 

Hamamelis, 447 

Lithium salicylate, 311 

Mezereum, 588 

Oil of turpentine, 326 

Phytolacca, 266 

Potassium iodide, 471 

Potassium nitrate, 464 

Salicylic acid, 310 

Sodium bicarbonate, 461 

Sodium phosphate, 541 

Solution of ammonium acetate, 573 

Sulphur, 526 

Sulphurous baths, 526 

Syrup of hydriodic acid, 472 

Tincture of iodine, 470 
Rheumatoid Arthritis — 

Arsenic, 395 

Colchicum, 580 
Rhinitis — 

Balsam of Peru, 355 

Eucalyptus, 336 
Rhus-poisoning — 

Grindelia, 354 

Hamamelis, 447 
Rigidity of Os Uteri — 

Ipecac, 514 
Ringworm — 

Acetic acid, 485 

Balsam of Peru, 355 

Copper sulphate, 425 
Round -worms — 

Salicylic acid, 311 



Salivary Fistula? — 

Chromic acid, 591 
Sarcoma — 

Arsenic, 393 
Scabies — 

Balsam of Peru, 355 

Copper sulphate, 425 

Hyposulphites, 283 

Naphthalene, 297 

Sulphur ointment, 525 

Tar, 357 
Scales, Removal of — 

Olive oil, 598 
Scarlatinous Dropsy — 

Solution of ammonium acetate, 573 
Scarlet Fever — 

Belladonna, 206 

Iron, 411 

Mustard bath, 323 

Sodium phenolsulphonate, 302 
Scarlet Fever, Angina of — 

Capsicum, 342 
Sciatica — 

Acetanilid, 379 

Blisters, 318 

Cantharidal plaster, 321 

Ether, 156 



Sciatica — 

Nitroglycerin, 271 

Potassium iodide, 471 

Salicylic acid, 311 

Sulphur, 525 
Sclerotitis — 

Salicylic acid, 311 
Scrofula — 

Cod-liver oil, 504 

Phytolacca, 266 

Potassium iodide, 471 
Scrofulous Glands — 

Zinc chloride, 593 

Zinc iodide, 423 
Scrofulous Ulcers — 

Phosphoric acid, 480 
Scrotal Hernia — 

White oak, 443 
Scurvy — 

Citric acid, 485 

Sulphuric acid, 482 
Seasickness — 

Acetanilid, 379 

Belladonna, 207 

Chloral, 174, 175 

Cocaine, 217 
Seatworms — 

Olive oil, 599 

Quassia, 497 
Sebaceous Cysts — 

Ether, 156 
Seborrhea — 

Hamamelis, 447 

Resorcin, 295 
Secretion of Milk, Checking- 
Belladonna, 206 
Seminal Losses — 

Blood-root, 560 
Senile Tremor — 

Cocaine, 217 
Septic Diseases — 

Sodium benzoate, 308 
Septicemia — 

Alcohol, 152 

Colloidal silver, 430 

Quinine, 372 

Serum-therapy, 612 
Septicemia, Puerperal — 

Opium, 187 
Sequestra, Removal of — 

Hydrochloric acid, 480 
Sexual Excitement — 

Camphor, 363 
Shock- 
Caffeine, 259 

Digitalis, 241 

Ether, 156 

Opium, 186 
Skin, Diseases of — 

Acetic acid, 485 

Alumnol, 297 

Aristol, 289 

Arsenic, 394 

Beta-naphthol, 297 



CLINICAL INDEX. 



689 



Skin, Diseases of — 

Cantharides, 321 

Carbolic acid, 292 

Castor oil, 521 

Cod-liver oil, 503 

Ether, 156 

Eucalyptus, 336 

Hydrochloric acid, 481 

Iodoform, 288 

Liquor potassae, 461 

Mercury, 401 

Mezereum, 588 

Naphthalene, 297 

Oleate of copper, 426 

Phytolacca, 266 

Pilocarpine, 572 

Potassium carbonate, 461 

Salicylic acid, 310 

Sulphur, 525^ 

Sulphuric acid, 482 

Sulphurous acid, 282 

Sulphurous baths, 526 

Tar, 357 

Thymol, 341 

Zinc oxide, 422 
Skin, Irritable and Inflamed Con- 
ditions of — 

Althaea, 601 
Skin, Irritable Conditions of — 

Magnesium carbonate, 461 
Skin, Sarcoma of — 

Arsenic, 393 
Smallpox — 

Alcohol, 151 

Glycerite of starch, 597 

Red rose, 449 
Sore Mouth, Mercurial — 

Silver nitrate, 429 
Sore Nipples — 

Silver nitrate, 429 

Tannic acid, 440 
Sore Throat- 
Acetic acid, 485 

Alum, 432 

Geranium, 448 

Hydrochloric acid, 480 

Liquorice, 556 
Sore Throat, Mercurial — 

Copper sulphate, 425 

Potassium permanganate, 279 
Sore Throat, Relaxed — 

Copper sulphate, 425 

Zinc sulphate, 423 
Sores — 

Alum, 433 

Balsam of Peru, 355 

Bismuth benzoate, 307 
Spasm — 

Belladonna, 205 

Conium, 221 

Opium, 186 
Spasm of Bladder — 

Cannabis, 193 



44 



Spasmodic Asthma — 

Belladonna, 206 

Bromides, 198 

Stramonium, 210 
Spasmodic Colic — 

Belladonna, 206 
Spasmodic Disorders of Childhood — 

Chloral, 174 
Spasmodic Dysmenorrhea — 

Belladonna, 206 
Spasmodic Rigidity of Os Uteri — 

Chloral, 174 
Spermatorrhea — 

Belladonna, 207 

Bromides, 198 

Camphor, 363 

Camphoric acid, 363 

Digitalis, 242 

Ergot, 252 

Strychnine, 232 

Tincture of cantharides, 321 

Turpentine, 327 
Spinal Diseases — 

Acetanilid, 379 

Cantharidal blister, 321 
Spinal Hyperemia — 

Belladonna, 207 
Spinal Meningocele — 

Tincture of iodine, 470 
Spine, Congestion of — 

Ergot, 252 
Spleen, Enlarged — 

Ergot, 252 

Plumbi iodide, 419 
Spleen, Syphilitic Enlargement of — 

Red iodide of mercury ointment, 402 
Spongy Gums — 

Krameria, 445 

Myrrh, 335 

Rhus glabra, 448 

Tannic acid, 440 

Tincture of benzoin, 307 
Sprains — 

Alcohol, 150 

Arnica, 267 

Camphor liniment, 362 

Hamamelis, 447 

Liquor plumbi subacetatis, 419 

Olive oil, 598 

Rhus toxicodendron, 330 

Tansy, 551 

Tincture of calendula, 497 
Status Epilepticus — 

Chloral, 174 
Stenosis of Mitral Orifice — 

Strophanthin, 244 
Sthenic Fevers — 

Acetanilid, 378 

Chloral, 174 
Stings, Insect — 

Olive oil, 598 

Rhus toxicodendron, 330 
Stomach, Dilatation of — 

Carbolic acid, 292 



690 



CLINICAL INDEX. 



Stomach, Diseases of — 

Opium, 188 
Stomach, Irritative Conditions of- 

Fowler's solution, 395 
Stomatitis — 

Alum, 432 

Bismuth subnitrate, 436 

Chlorine water, 284 

Geranium, 448 

Red rose, 449 

Rhus glabra, 448 

Salicylic acid, 310 

Silver nitrate, 429 

Tannic acid, 440 

Thymol, 341 

Zinc sulphate, 423 
Strabismus — 

Bromides, 198 . ' 

Strangury — 

Demulcents, 595 
Stricture — 

Aconite, 262 

Olive oil, 599 

Suprarenal extract, 255 
Strychnine-poisoning — 

Amyl nitrite, 271 

Bromides, 198 

Chloral, 174 
Subinvolution — 

Cotton-root bark, 253 

Ergot, 252 

Glycerite of tannic acid, 597 
Suppuration of Middle Ear — 

Resorcin, 295 
Sweating — 

Alcohol, 150 

Alum, 433 

Belladonna, 206 

Bismuth subnitrate, 436 

Chloral, 173 

Chromic acid, 590 

Citric acid, 485 

Ergot, 252 

Hamamelis, 447 

Pilocarpine, 571 

Plumbi oxidum, 419 

Silver oxide, 429 

Sulphuric acid, 481 

Tannic acid, 440 

Zinc oxide, 422 
Swellings — 

Ammonium chloride, 555 

Piperazin, 568 
Swollen Gums — 

Alum, 432 
Sycosis — 

Hyposulphites, 283 

Phytolacca, 266 

R< sorcin, 295 

Salicylic acid, 310 

Salol, 312 

Sulphur, 525 

Tannic acid, 440 



Synoope — 

Alcohol, 151 

Mustard, 323 
Synovitis — 

Belladonna ointment, 206 

Cantharidal blister, 321 

Ichthyol, 304 

Iodoform, 288 

Lead acetate, 418 

Mercurial ointment, 401 

Rubefacients, 587 

Tincture of iodine, 470 

Vesicants, 318 
Syphilis — 

Arsenic, 395 

Chromic acid, 590 

Guaiac, 583 

Iodides, 471 

Iron, 411 

Mercurial preparations, 401, 402 

Nitrohydrochloric acid, 481 

Phytolacca, 266 

Sarsaparilla, 582 

Serum-therapy, 613 

Thyroid extract, 606 

Zinc chloride, 593 
Syphilitic Enlargement of Spleen — 

Red iodide of mercury ointment, 402 
Syphilitic Mucous Patches- 
Potassium chlorate, 492 
Syphilitic Orchitis — 

Mercurial ointment, 401 
Syphilitic Periostitis — 

Iodides, 471 
Syphilitic Ulcerations of Tongue — 

Papain, 500 
Syphilitic Ulcers — 

Alumnol, 297 

Iodoform, 288 

Potassium permanganate, 279 

Resorcin,295 
Syphilodermata — 

Cod-liver oil, 504 



Tabes- 
Strychnine, 231 

Tabes Dorsalis — 
Acetanilid, 379 

Taenia Circinata — 
Carbolic acid, 292 

Taenia Solium — 
Carbolic acid, 293 

Taeniae — 

Aspidium, 545 
Santonin, 544 

Tapeworm— 
Aspidium, 545 
Ether, 156 
Kousso, 546 
Pomegranate, 547 
Pumpkin seed, 547 
Salicylic acid, 311 
Turpentine, 326 



CLINICAL INDEX. 



691 



Tenesmus, Vesical — 

Hyoscyamus, 209 
Testis, Tuberculosis of — 

Camphorated naphthol, 298 
Tetanus — 

Acetanilid, 379 

Amyl nitrite, 271 

Chloral, 174 

Gelsemium, 224 

Opium, 186 

Salicylic acid, 311 

Serum-therapy, 609 
Thirst, to Quench — 

Demulcents, 595 
Thread-worms — 

Rhubarb, 530 
Throat, Diseases of — 

Ammonium chloride, 555 

Aristol, 289 

Cubeb, 353 ^ 

Hydrogen dioxide, 278 

Iodoform, 288 

Liquor potassae, 461 

Mercury, 401 

Nitric acid, 480 

Oil of peppermint, 339 

Opium, 185 

Potassium chlorate, 492 

Sulphur, 525 

Tar, 358 

Thymol, 341 

Turpentine, 326 
Throat, Dryness of — 

Pilocarpine, 571 
Throat, Inflammation of — 

Carbolic acid, 292 
Throat, Irritation of — 

Cannabis, 193 
Throat, Relaxed— 

Geranium, 448 

Myrrh, 335 

Sodium phenolsulphonate, 302 
Throat, Tickling of— 

Cannabis, 193 
Thrombosis — 

Ammonia, 274 
Thrush- 
Sodium bicarbonate, 461 

Sodium phenolsulphonate, 302 
Tic Douloureux — 

Aconite, 262 

Opium, 187 

Veratrine ointment, 264 
Tickling of Throat— 

Cannabis, 193 
Tics— 

Conium, 221 
Tinea Capitis — 

Carbolic acid, 292 
Tinea Circinata — 

Cantharidal blister, 321 
Tinea Sycosis — 

Copper sulphate, 425 
Tinea Tarsi — 

Copper sulphate, 425 



Tinea Tonsurans — 

Cantharidal blister, 321 

Carbolic acid, 292 

Hydronaphthol, 298 

Tincture of iodine, 470 

Turpentine, 326 
Tinea Versicolor — 

Sulphur ointment, 525 
Tobacco Habit — 

Cocaine, 217 
Tobacco Heart — 

Strophanthin, 244 
Toe-nail, Ingrowing — 

Alum, 433 

Liquor potassae, 460 
Tongue, Fissure of — 

Glycerin, 597 
Tongue, Syphilitic Ulcerations of — 

Papain, 500 
Tongue, Tuberculosis of— 

Chromic acid, 590 
Tongue, Tuberculous Ulcerations of — 

Camphorated naphthol, 298 
Tonsillitis — 

Acetanilid, 378 

Aconite, 262 

Alum, 432 

Camphorated naphthol, 298 

Diuretics, 564 

Gallic acid, 441 

Guaiac, 583 

Guaiacol, 302 

Iron, tincture of chloride of, 411 

Phytolacca, 266 

Quinine, 367 

Rhus glabra, 448 

Salicylic acid, 311 

Silver nitrate, 429 

Sodium phenolsulphonate, 302 

Tannic acid, 440 
Tonsils, Enlarged — 

Chromic acid, 590 

Zinc iodide, 423 

Zinc sulphate, 423 
Tonsils, Indurated — 

Zinc iodide, 423 
Toothache — 

Camphorated chloral, 173 

Capsicum, 343 

Creosote, 300 

Oil of cloves, 345 
Torpor of Liver — 

Podophyllum, 538 
Torticollis — 

Capsicum, 342 
Trachea, Congestion of — 

Creosote, 300 
Tracheitis — 

Ipecac, 513 

Silver nitrate, 429 

Terpin hydrate, 328 
Trachoma — 

Alum, 432 

Bismuth subnitrate, 436 



692 



CLINICAL INDEX. 



Trachoma Condylomata — 

Copper sulphate, 425 
Tremor — 

Cocaine, 217 
Trichophytosis — 

Gallanol, 442 
Tuberculosis — 

Apomorphine, 508 

Benzoyl-eugenol, 345 

Bone-marrow, 607 

Camphorated naphthol, 298 

Cod-liver oil, 504 

Iron, 411 

Nuclein, 607 

Serum -therapy, 611 
Tuberculosis of Testis — 

Camphorated naphthol, 298 
Tuberculosis of Tongue — 

Chromic acid, 590 
Tuberculous Adenitis — 

Camphorated naphthol, 298 
Tuberculous Affections — 

Iodoform, 288 
Tuberculous Glands — 

Phosphoric acid, 480 
Tuberculous Ulceration — 

Lactic acid, 483 
Tuberculous Ulcerations of Tongue — 

Camphorated naphthol, 298 
Tumors — 

Zinc sulphate, 423 
Tumors of Uterus — 

Cotton-root bark, 253 
Turgescence of Nasal Mucous Mem- 
brane — 

Cubeb, 353 
Tylosis — 

Salicylic acid, 310 
Tympanic Membrane, Perforations 
of — 

Carbolic acid, 292 
Tympanites — 

Asafetida, 362 

Turpentine, 326 
Typhoid Fever — 

Acacia, 600 

Acetanilid, 378 

Alcohol, 151 

Belladonna, 206 

Bismuth subsalicylate, 436 

Camphor, 363 

Carbolic acid, 293 

Chloral, 173 

Digitalis, 241 

Hexamethylenamine, 569 

Hydrochloric acid, 481 

Ilvdronaphthol, 298 

Hyposulphites, 283 

Iron, 411 

Lead acetate, 419 

Naphthalene, 297 

Nuclein, 607 

Oxgall, 529 

Potassium chlorate, 492 



Typhoid Fever — 

Quinine, 372 
Serpentaria, 497 
Serum-therapy, 613 
Sodium phenolsulphonate, 302 
Strychnine, 231 
Suprarenal extract, 256 
Thymol, 341 
Turpentine, 326 
Typhus Fever — 
Alcohol, 151 
Camphor, 363 
Chloral, 173 
Serpentaria, 497 



Ulceration — 

Castor oil, 521 
Ulceration, Aphthous — 

Potassium chlorate, 492 
Ulceration, Intestinal — 

Silver nitrate, 429 
Ulceration of Cartilaginous Struc- 
tures — 

Potassium iodide, 471 
Ulceration of Larynx — 

Silver nitrate, 429 
Ulceration of Mouth — 

Chromic acid, 590 
Ulceration of Rectum — 

Silver nitrate, 429 
Ulceration, Phagedenic — 

Nitric acid, 480 

Solution of nitrate of mercury, 402 
Ulceration, Syphilitic, of Tongue — 

Papain, 500 
Ulceration, Tuberculous — 

Calcium phosphate, 388 

Lactic acid, 483 
Ulceration, Venereal, of Os Uteri — 

Solution of nitrate of mercury, 402 
Ulcerous Gums — 

Tannic acid, 440 
Ulcers- 
Alcohol, 150 

Alum, 433 

Alumen Exsiccatum, 433 

Alumnol, 297 

Aristol, 289 

Bismuth benzoate, 307 

Bismuth subgallate, 436 

Bismuth subiodide, 437 

Bismuth subnitratc, 436 

Camphor-ice, 362 

Cantharidal blister, 320 

Carbolic acid, 292 

Chloral, 173 

Chromic acid, 591 

Conium, 221 

Copper sulphate, 425 

Eucalyptus, 336 

Eluidcxtract of Hydrastis, 234 

Geranium, 448 



CLINICAL INDEX. 



693 



Ulcers — 

Hamamelis, 447 

Hydrogen dioxide, 277 

Iodoform, 288 

Iron sulphate, 411 

Kino, 444 

Lycopodium, 603 

Nuclein, 607 

Nutgall ointment, 442 

Phytolacca, 266 

Potassium chlorate, 492 

Potassium permanganate, 279 

Red rose, 449 

Resorcin, 295 

Rhus glabra, 448 

Salol, 312 

Silver nitrate, 429 

Solution of chlorinated soda, 285 

Tannic acid, 440 

Tar, 357 

Vesicants, 318 

White oak, 443 

Zinc chloride, 593 

Zinc oxide, 422 

Zinc sulphate, 422 
Ulcers, Gastric — 

Arsenic, 395 

Bismuth subnitrate, 436 

Lead acetate, 419 

Manganese dioxide, 413 

Pepsin, 498 

Potassium dichromate, 490 

Resorcin, 295 

Silver nitrate, 429 

Silver oxide, 429 
Ulcers of Cornea — 

Eserine, 577 
Ulcers of Mouth and Throat — 

Tincture of hydrastis, 234 
Ulcers, Rectal- 
Potassium chlorate, 492 
Ulcers, Scrofulous — 

Phosphoric acid, 480 
Ulcers, Venereal — 

Calomel, 401 
Uncinaria Americana — 

Thymol, 341 
Uncinaria Duodenale — 

Thymol, 341 
Uremia — 

Opium, 186 
Uremic Convulsions — 

Chloral, 174 
Uremic Poisoning — 

Pilocarpine, 571 
Urethral Caruncles — 

Cocaine, 216 
Urethritis — 

Buchu, 347 

Elm, 600 
Uric-acid Diathesis — 

Diuretics, 564 
Urinary Apparatus, Affections of — 

Spirit of nitrous ether, 574 



Urinary Organs Inflamed Conditions 
of — 

Althaea, 601 
Urine, Incontinence of — 

Ammonium benzoate, 307 

Belladonna, 206 

Buchu, 347 

Ergot, 252 

Hyoscyamus, 209 

Tincture of cantharides, 321 
Urticaria — 

Alcohol, 150 

Anderson's powder, 362 

Citric acid, 485 

Copaiba, 351 

Ergot, 252 

Ether, 156 

Hamamelis, 447 

Liquor plumbi subacetatis, 419 

Menthol, 339 

Sulphurous acid, 282 
Uterine Cancer — 

Iodoform, 288 
Uterine Contractions, to Promote — 

Ergot, 252 

Quinine, 372 
Uterine Fibroids — 

Ergot, 252 
Uterine Hemorrhage — 

Alcohol, 150 

Ergot, 252 

Hydrastine, 234 

Ipecac, 514 

Krameria, 445 

Nitric acid, 480 

Senegin, 557 

White oak, 443 
Uterine Polypi — 

Ergot, 252 
Uterine Ulcerations — 

Fluidextract of hydrastis, 234 
Uterus, Cancer of — 

Tannic acid, 440 
Uterus, Congestion of — 

Glycerite of tannic acid, 597 
Uterus, Diseases of — 

Solution of chlorinated soda, 285 
Uterus, to Dilate Neck of— 

Elm, 600 
Uterus, Tumors of— 

Cotton root bark, 253 
Uterus, Ulceration of — 

Iodoform, 288 
Uvula, Relaxed — 

Alum, 432 

Capsicum, 342 

Kino, 444 

Krameria, 445 

White oak, 443 

Vagina, Diseases of — 

Solution of chlorinated soda, 285 
Vagina, Relaxed — 

Geranium, 448 



6 9 4 



CLINICAL INDEX. 



Vaginal Ulcerations — 

Fluidextract of hydrastis, 234 
Vaginitis — 

Ammonium chloride, 555 

Copaiba, 350 

Lime water, 461 
Valvular Diseases of Heart 

Caffeine, 258 

Casca bark, 248 

Diuretin, 566 

Iodides, 471 
Varicocele — 

Ergotin, 252 
Varicose Ulcers — 

Hamamelis, 447 
Varicose Veins — 

Ergotin, 252 
Variola. See Smallpox. 
Vegetations — 

Chromic acid, 590 
Veins, Varicose — 

Ergotin, 252 
Venereal Bubo — 

Tincture of iodine, 470 
Venereal Sores — 

Black wash, 461 

Hydrogen dioxide, 278 

Yellow wash, 461 
Venereal Ulcerations of Os Uteri 

Solution of nitrate of mercury, 402 
Venereal Ulcers — 

Calomel, 401 

Salol, 312 
Venereal Warts — 

Nitric acid, 480 
Venomous Reptiles, Poisoning by — 

Alcohol, 150 

Ammonia, 274 
Verruca — 

Salicylic acid, 310 
Verrucosities — 

Alum, 432 
Vertigo — 

Valerian, 363 
Vesical Calculi — 

Piperazin, 568 
Vesical Catarrh — 

Silver nitrate, 429 

Tar water, 358 
Vesical Tenesmus — 

Hyoscyamus, 209 
Vomiting — 

Alcohol, 151 

Bismuth subnitrate, 436 

Caffeine, 259 

Cantharidal blister, 321 

Carbolic acid, 292 

Cocaine, 217 

Ipecac, 513 

Lime water, 462 

Menthol, 339 

Quinine, 372 
Vomiting, Cerebral — 

Ammonium bromide, 198 



Vomiting of Phthisis — 

Strychnine, 231 
Vomiting of Pregnancy — 

Ammonium bromide, 198 

Cerium oxalate, 437 

Chloral, 174 

Strychnine, 23 r 

Tincture of iodine, 472 
Vulva, Eruption on — 

Borax, 489 
Vulvitis — 

Zinc sulphate, 423 

Warts- 
Chromic acid, 590 

Glacial acetic acid, 485, 592 

Nitric acid, 480 

Potassium dichromate, 490 

Salicylic acid, 310 

Trichloracetic acid, 485 
Wasting Diseases — 

Phosphoric acid, 481 
Whooping-cough — 

Acetanilid, 379 

Alum, 433 

Ammonium chloride, 555 

Antipyrine, 375 

Asafetida, 362 

Belladonna, 206 

Bromides, 198 

Bromoform, 199 

Caffeine, 259 

Chloral, 174 

Cod-liver oil, 503 

Ergot, 252 

Grindelia, 354 

Hyoscyamus, 209 

Quinine, 371 

Resorcin, 295 

Silver nitrate, 429 

Tannic acid, 440 

Terebene, 328 
Winter- cough — 

Ipecac, 513 

Terebene, 328 
Wounds — 

Alcohol, 150 

Bismuth subgallate, 436 

Bismuth subnitrate, 436 

Campho-phenique, 362 

Chlorine water, 284 

Compound tincture of benzoin, 307 

Glycerin, 597 

Iodoform, 288 

Oil of turpentine, 326 

Olive oil, 598 

Resorcin, 295 

Rhus glabra, 448 

Salol, 312 

Silver nitrate, 429 

Sulphurous acid, 282 

Yellow Fever — 
Hyposulphites, 283 
Lead acetate, 419 



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Atlas and Epitome of the Nervous System and Its Diseases. 

By Professor Dr. Chr. Jakob, of Erlangen. From the Second Revised 
German Edition. Edited, with additions, by Edward D. Fisher, M. D., 
Professor of Diseases of the Nervous System, University and Bellevue 
Hospital Medical College, New York. With 83 plates and copious text. 
Cloth, $3.50 net. /;/ Saunders' Hand-Atlas Series. 

The matter is divided into Anatomy, Pathology, and Description of Diseases 
of the Nervous System. The plates illustrate these divisions most completely ; 
especially is this so in regard to pathology. The exact site and character of the 
lesion are portrayed in such a way that they cannot fail to impress themselves on 
the memory of the reader. 

Philadelphia Medical Journal 

" We know of no one work of anything like equal size which covers this important and 
complicated field with the clearness and scientific fidelity of this hand-atlas." 






DISEASES OF CHILDREN. 



American Text-Book of 
Diseases of Children 

American Text=Book of Diseases of Children. Edited by Louis 
Starr, M. D., Consulting Pediatrist to the Maternity Hospital, etc. ; 
assisted by Thompson S. Westcott, M. D., Attending Physician to the 
Dispensary for Diseases of Children, Hospital of the University of Penn- 
sylvania. Handsome octavo, 1244 pages, profusely illustrated. Cloth, 
$7.00 net ; Sheep or Half Morocco, $8.00 net. 

SECOND REVISED EDITION 

To keep up with the rapid advances in the field of pediatrics, the whole sub- 
ject-matter embraced in the first edition has been carefully revised, new articles 
added, some original papers amended, and a number entirely rewritten and 
brought up to date. The volume has thus been increased in size by a very 
considerable amount of fresh material. 

British Medical Journal 

" May be recommended as a thoroughly trustworthy and satisfactory guide to the subject 
of the diseases of children." 

Paul's Fever Nursing 



Nursing in the Acute Infectious Fevers. By George P. Paul, 
M. D., Assistant Visiting Physician and Adjunct Radiographer to the 
Samaritan Hospital, Troy, N. Y. i2mo volume of 200 pages. 

JUST ISSUED 



Dr. Paul has written this little work especially for the trained nurse, so that all 
extraneous matter has been studiously avoided. The author has laid great stress 
upon care and management in each disease, as this relates directly to the duties 
of the nurse. The book is divided into three parts. The first part treats of fever 
in its general aspects ; the second discusses each of the acute infectious fevers, 
giving cause, signs, symptoms, course, prognosis, care, and management ; the 
third deals with practical procedures and information necessary to the proper 
management of the diseases discussed. 



io SAUNDERS' BOOKS ON 

Friedenwald 6 Ruhrah's 
Dietetics for Nurses 



Dietetics for Nurses. By Julius Friedenwald, M. D., Clinical 
Professor of Diseases of the Stomach, College of Physicians and Sur- 
geons, Baltimore ; and John Ruhrah, M. D., Clinical Professor of 
Diseases of Children, College of Physicians and Surgeons, Baltimore. 
i2mo of 363 pages. Cloth, $1.50 net. 

JUST ISSUED 

This work has been prepared to meet the needs of the nurse, both in the 
training school and after graduation. It aims to give the essentials of dietetics, 
considering briefly the physiology of digestion and the various classes of foods 
and the part they play in nutrition. The subjects of infant feeding and the feeding 
of the sick are fully discussed, and a brief outline is given of the principles 
involved in the nourishment of patients suffering from the various diseases in which 
diet plays an important part in treatment. Rectal alimentation and the feeding 
of operative cases are fully described. Diet-lists and recipes for tne invalid's 
dietary are appended. 

Lewis' Anatomy and 
Physiology for Nurses 

Anatomy and Physiology for Nurses. By LeRoy Lewis, M. D., 
Surgeon to and Lecturer on Anatomy and Physiology for Nurses at 
the Lewis Hospital, Bay City, Michigan. i2mo of 317 pages, with 
146 illustrations. Cloth, $1.7$ net. 

JUST ISSUED 

The author has based the plan and scope of the work on the methods he has 
employed in teaching the subjects, and has made the text unusually simple and 
clear. The object was so to deal with anatomy and physiology that the student 
might easily grasp the primary principles, at the same time laying a broad foun- 
dation for a wider study. The text is rendered more comprehensive by the 
practical illustrations, representing the best that could be obtained. 



NURSING. 1 1 



De Lee's Obstetrics for Nurses 

Obstetrics for Nurses. By Joseph B. De Lee, M.D., Professor 
of Obstetrics in the Northwestern University Medical School; Lecturer 
in the Nurses' Training Schools of Mercy, Wesley, Provident, Cook 
County, and Chicago Lying-in Hospitals. i2mo volume of 460 pages, 
fully illustrated. Cloth, $2.50 net. 

RECENTLY ISSUED 

The illustrations in Dr. De Lee's work are nearly all original, and represent 
photographs taken from actual scenes. The text is the result of the author's eight 
years' experience in lecturing to the nurses of five different training schools. 

J. Clifton Edgar, M. D., 

Professor of Obstetrics and Clinical Midwifery , Cornell Medical School, N. Y. 
" It is far-and-away the best that has come to my notice, and I shall take great pleasure in 
recommending it to my nurses, and students as well." 

Davis' Obstetric and 
Gynecologic Nursing 

Obstetric and Gynecologic Nursing. By Edward P. Davis, A.M., 

M. D., Professor of Obstetrics, Jefferson Medical College and Philadel- 
phia Polyclinic. i2mo of 400 pages, illustrated. Buckram, $1.75 net. 

RECENTLY ISSUED— SECOND REVISED EDITION 

The Lancet, London 

" Not only nurses, but even newly qualified medical men, would learn a great deal by a 
perusal of this book. It is written in a clear and pleasant style, and is a work we can recom- 
mend." 

Reference Handbook for Nurses 

A Reference Handbook for Nurses. By Amanda K. Beck, of 
Chicago, 111. 32010 of 177 pages. Flexible morocco, $1.25 net. 

RECENTLY ISSUED 

This little book contains information upon every question that comes to a 
nurse in her daily work, and embraces all the information that she requires to 
carry out any directions given by the physician. It covers also information on all 
emergencies that may arise between or before visits of the physician, and 
includes articles on massage, medical electricity, obstetrics, care of infants, etc. 



SAUXDERS" BOOKS ON 



Hofmann and Peterson's 
Legal Medicine 

Atlas of Legal Medicine. By Dr. E. von Hofmann, of Vienna, 
Edited by Frederick Peterson, M. D., Clinical Professor of Psychi- 
atry in the College of Physicians and Surgeons, New York. With 120 
colored figures on 56 plates and 193 half-tone illustrations. Cloth, 
$3.50 net. In Saunders' Hand- Atlas Series. 

By reason of the wealth of illustrations and the fidelity of the colored plates, 
the book supplements all the text-books on the subject. Moreover, it furnishes to 
even' physician, student, and lawyer a veritable treasure-house of information. 

The Practitioner, London 

" The illustrations appear to be the best that have ever been published in connection with 
this department of medicine, and they cannot fail to be useful alike to the medical jurist and to 
the student of forensic medicine." 

Chapman's 
Medical Jurisprudence 

Medical Jurisprudence, Insanity, and Toxicology. By Henry C. 
Chapman, M. D., Professor of Institutes of Medicine and Medical 
Jurisprudence in Jefferson Medical College, Philadelphia. Handsome 
i2mo of 329 pages, fully illustrated. Cloth, $1.75 net. 

RECENTLY ISSUED— THIRD REVISED EDITION, ENLARGED 

This work is based on the author's practical experience as coroner's physician 
of the city of Philadelphia for a period of six years. Dr. Chapman's book, 
therefore, is of unusual value. 

This third edition has been thoroughly revised and greatly enlarged, so as to 
bring it absolutely in accord with the very latest advances in this important branch 
of medical science. There is no doubt it will meet with as great favor as the 
previous editions. 

Medical Record, New York 

"The manual is essentially practical, and is a useful guide for the general practitioner, 
besides possessing literary merit." 



iXURSING. 



Golebiewski and Bailey's 
Accident Diseases 



Atlas and Epitome of Diseases Caused by Accidents. By Dr. Ed. 

Golebiewski, of Berlin. Edited, with additions, by Pearce Bailey, 
M.D., Consulting Neurologist to St. Luke's Hospital, New York. 
With J I colored illustrations on 40 plates, 143 text-illustrations, and 
549 pages of text. Cloth, §4.00 net. In Saunders 1 Hand-Atlas 
Series. 

This work contains a full and scientific treatment of the subject of accident 
injury ; the functional disability caused thereby ; the medicolegal questions in- 
volved, and the amount of indemnity justified in given cases. The work is 
indispensable to every physician who sees cases of injury due to accidents, to 
advanced students, to surgeons, and, on account of its illustrations and statistical 
data, it is none the less useful to accident-insurance organizations. 

The Medical Record, New York 

" This volume is upon an important and only recently systematized subject, which is grow- 
ing in extent all the time. The pictorial part of the book is very satisfactory." 

Stoney's 
Materia Medica for Nurses 



Practical Materia Medica for Nurses, with an Appendix containing 
Poisons and their Antidotes, with Poison-Emergencies ; Mineral Waters ; 
Weights and Measures ; Dose-List, and a Glossary of the Terms used 
in Materia Medica and Therapeutics. By Emily M. A. Stoxey, Super- 
intendent of the Training School for Nurses at the Carney Hospital, 
South Boston, Mass. Handsome octavo of 300 pages. Cloth, S1.50 net. 

RECENTLY ISSUED— SECOND REVISED EDITION 

In making the revision for this new second edition, all the newer drugs have 
been introduced and fully discussed. The consideration of the drugs includes 
their sources and composition, their various preparations, physiologic actions, 
directions for administering, and the symptoms and treatment of poisoning. 

Journal of the American Medical Association 

" So far as we can see, it contains everything that a nurse ought to know in regard to drugs. 
As a reference-book for nurses it will without question be very useful." 



14 SAUNDERS' BOOKS ON 



Stoney's Nursing 



Practical Points in Nursing: for Nurses in Private Practice. By 
Emily M. A. Stoney, Superintendent of the Training School for Nurses 
at the Carney Hospital, South Boston, Mass. 466 pages, fully illus- 
trated. Cloth, $1.75 net. 

THIRD EDITION, THOROUGHLY REVISED— RECENTLY ISSUED 

In this volume the author explains the entire range of private nursing as dis- 
tinguished from hospital nursing, and the nurse is instructed how best to meet the 
various emergencies of medical and surgical cases when distant from medical or 
surgical aid or when thrown on her own resources. An- especially valuable feature 
will be found in the directions how to improvise everything ordinarily needed in the 
sick-room. 

The Lancet, London 

"A very complete exposition of practical nursing in its various branches, including obstetric 
and gynecologic nursing. The instructions given are full of useful detail." 



Stoney's Technic for Nurses 

Bacteriology and Surgical Technic for Nurses. By Emily M. A. 
Stoney, Superintendent at Carney Hospital, South Boston. Revised 
by Frederic R. Griffith, M. D., Surgeon, of New York. i2mo, 
278 pages, illustrated. Cloth, $1.50 net. 

RECENTLY ISSUED— NEW (2d) EDITION 
Trained Nurse and Hospital Review 

" These subjects are treated most accurately and up to date, without the superfluous reading 
which is so often employed. . . . Nurses will find this book of the greatest value both during 
their hospital course and in private practice." 

Spratling on Epilepsy 

Epilepsy and Its Treatment. By William P. Spratling, M. D., 
Medical Superintendent of the Craig Colony for Epileptics, Sonyea, 
New York. Octavo of 522 pages, fully illustrated. Cloth, $4.00 net. 

The Lancet, London 

" Dr. Spratling's work is written throughout in a clear and readable style. . . . The work 
is a mine of information on the whole subject of epilepsy and its treatment." 



CHILDREN AND HYGIENE. 15 

Griffith's Care of the Baby 

The Care of the Baby. By J. P. Cromer Griffith, M. D., Clinical 
Professor of Diseases of Children, University of Penn. ; Physician to the 
Children's Hospital, Phila. i2mo, 436 pp. Illustrated. Cloth, $1.50 net. 

RECENTLY ISSUED— THIRD EDITION, THOROUGHLY REVISED 

The author has endeavored to furnish a reliable guide for mothers. He has 
made his statements plain and easily understood, in the hope that the volume 
may be of service not only to mothers and nurses, but also to students and practi- 
tioners whose opportunities for observing children have been limited. 

New York Medical Journal 

"We are confident if this little work could find its way into the hands of every trained 
nurse and of every mother, infant mortality would be lessened by at least fifty per cent." 



Crothers* Morphinism 

Morphinism and Narcomania from Opium, Cocain, Ether, Chloral, 
Chloroform, and other Narcotic Drugs ; also the Etiology, Treatment, 
and Medicolegal Relations. By T. D. Crothers, M. D., Superintendent 
of Walnut Lodge Hospital, Hartford, Conn. Handsome i2mo of 351 
pages. Cloth, $2.00 net. 

The Lancet, London 

"An excellent account of the various causes, symptoms, and stages of morphinism, the 
discussion being throughout illuminated by an abundance of facts of clinical, psychological, and 
social interest." 

Abbott's Transmissible Diseases 

The Hygiene of Transmissible Diseases : Their Causation, Modes 
of Dissemination, and Methods of Prevention. By A. C. Abbott, M. D., 
Professor of Hygiene and Bacteriology, University of Pennsylvania. 
Octavo, 351 pages, with numerous illustrations. Cloth, $2.50 net. 

SECOND REVISED EDITION 

During the interval that has elapsed since the appearance of the first edition 
investigations upon the modes of dissemination of certain of the specific infections 
have been very active. The sections on Malaria, Yellow Fever, Plague, Filariasis, 
Dysentery, and Tuberculosis have been both revised and enlarged. 

The Lancet, London 

" We heartily commend the book as a concise and trustworthy guide in the subject with 
which it deals, and we sincerely congratulate Professor Abbott." 



16 SAUNDERS' BOOKS ON CHILDREN. 

American Pocket Dictionary ^ecendyhs^eT^ 

American Pocket Medical Dictionary. Ldited by W. A. New- 
man Dorland, M. D., Assistant Obstetrician to the Hospital of the 
University of Pennsylvania. Containing the pronunciation and defini- 
tion of the principal words used in medicine and kindred sciences, with 
64 extensive tables. Handsomely bound in flexible leather, with gold 
edges, $1.00 net; with patent thumb index, $1.25 net. 

" I can recommend it to our students without reserve." — J. H. HOLLAND, M. D., Dean 
of the Jefferson Medical College, Philadelphia. 

Warwick and Tunstall's First Aid 

First Aid to the Injured and Sick. By F. J. Warwick, B. A., 
M. B. Cantab., Associate of King's College, London; and A. C. Tun- 
stall, M. D., F. R. C. S. Edin., Surgeon-Captain Commanding the East 
London Volunteer Brigade Bearer Company. i6mo of 232 pages and 
nearly 200 illustrations. Cloth, $1.00 net. 

Powell's Diseases Of Children Third Edition, Revised 

Essentials of the Diseases of Children. By William M. Powell, 
M. D. Revised by Alfred Hand, Jr., A. B., M. D., Dispensary 
Physician and Pathologist to the Children's Hospital, Philadelphia. 
i2mo volume of 259 pages. Cloth, $1.00 net. In Saunders' 
Question- Compend Series. 

Shaw on Nervous Diseases and Insanity PouAawon 

Essentials of Nervous Diseases and Insanity : Their Symptoms 
and Treatment. A Manual for Students and Practitioners. By the late 
John C. Shaw, M. D., Clinical Professor of Diseases of the Mind and 
Nervous System, Long Island College Hospital, New York. i2mo of 
204 pages, illustrated. Cloth, $1.00 net. In Saunders' Question- Com- 
pend Series. 

" Clearly and intelligently written ; we have noted few inaccuracies and several sug- 
gestive points. Some affections unmentioned in many of the large text-books are noted." 
— Boston Medical and Surgical Journal. 

Starr's Diets for Infants and Children 

Diets for Infants and Children in Health and in Disease. By 
Louis Starr, M. D., Consulting Pediatrist to the Maternity Hospital, 
Philadelphia. 230 blanks (pocket-book size). Bound in flexible Morocco, 
Si. 25 net. 

Grafstrom's Mechano-Therapy secon^RevLd Edition 

A Text-p,ook of Mechano-therapy (Massage and Medical Gymnas- 
tics). By Axel V. Grafstrom, B. Sc, M. D., Attending Physician to 
the Gustavus Adolphus Orphange, Jamestown, New York. 121110, 200 
pages, illustrated. Cloth, $1.25 net. 






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